Chronic obstructive pulmonary disease exacerbation in the intensive care unit: clinical, functional and quality of life at discharge and 3 months of follow up. / Exacerbação de doença pulmonar obstrutiva crônica na unidade de terapia intensiva: avaliação clínica, funcional e da qualidade de vida na alta e após 3 meses de seguimento.

OBJECTIVE:: The purpose of this study was to evaluate the clinical/functional aspects and quality of life of chronic obstructive pulmonary disease patients who were discharged after an intensive care unit admission for acute respiratory failure. METHODS:: This prospective study included chronic obstructive pulmonary disease patients who were admitted to two intensive care units between December of 2010 and August of 2011 and evaluated over three visits after discharge. Thirty patients were included, and 20 patients completed the three-month follow up. RESULTS:: There was a significant improvement in the following: forced expiratory flow in one second (L) (1.1/1.4/1.4; p = 0.019), six-minute walk test (m) (- /232.8 /272.6; p = 0.04), BODE score (7.5/5.0/3.8; p = 0.001), cognition measured by the Mini Mental State Examination (21/23.5/23.5; p = 0.008) and quality of life measured by the total Saint George Respiratory Questionnaire score (63.3/56.8/51, p = 0.02). The mean difference in the total score was 12.3 (between visits 1 and three). Important clinical differences were observed for the symptom score (18.8), activities score (5.2) and impact score (14.3). The majority of participants (80%) reported they would be willing to undergo a new intensive care unit admission. CONCLUSION:: Despite the disease severity, there was a significant clinical, functional and quality of life improvement at the end of the third month. Most patients would be willing to undergo a new intensive care unit admission.

Exacerbação de doença pulmonar obstrutiva crônica na unidade de terapia intensiva: avaliação clínica, funcional e da qualidade de vida na alta e após 3 meses de seguimento / Chronic obstructive pulmonary disease exacerbation in the intensive care unit: clinical, functional and quality of life at discharge and 3 months of follow up

RESUMO Objetivo: Avaliar aspectos clínicos e funcionais, assim como qualidade de vida de pacientes com doença pulmonar obstrutiva crônica após receberem alta da unidade de terapia intensiva à qual foram admitidos por insuficiência respiratória aguda. Métodos: Estudo prospectivo que incluiu pacientes com doença pulmonar obstrutiva crônica admitidos a duas unidades de terapia intensiva entre dezembro de 2010 e agosto de 2011, e que foram avaliados em três visitas após a alta da unidade de terapia intensiva. Incluíram-se 31 pacientes e, destes, 20 pacientes completaram o seguimento de 3 meses. Resultados: Ocorreu melhora significante dos seguintes aspectos: volume expiratório forçado em 1 segundo (L) (1,1/1,4/1,4; p = 0,019), Teste de Caminhada de 6 Minutos (m) (- /232,8/272,6; p = 0,04), escore BODE (7,5/5,0/3,8; p = 0,001), cognição avaliada com uso da escala Mini Mental State Examination (21/23,5/23,5; p = 0,008) e qualidade de vida avaliada pelo Saint George Respiratory Questionnaire (63,3/56,8/51; p = 0,02). A diferença média no escore total foi de 12,3 (entre as visitas um e três). Observaram-se diferenças clínicas importantes em relação ao escore de sintomas (18,8), escore de atividades (5,2) e escore de impacto (14,3). A maior parte dos participantes (80%) relatou que aceitaria uma nova admissão à unidade de terapia intensiva. Conclusão: Apesar da gravidade da doença, ao final do terceiro mês ocorreu uma significativa melhora clínica, funcional e de qualidade de vida. A maior parte dos pacientes aceitaria submeter-se a uma nova internação na unidade de terapia intensiva.

ABSTRACT Objective: The purpose of this study was to evaluate the clinical/functional aspects and quality of life of chronic obstructive pulmonary disease patients who were discharged after an intensive care unit admission for acute respiratory failure. Methods: This prospective study included chronic obstructive pulmonary disease patients who were admitted to two intensive care units between December of 2010 and August of 2011 and evaluated over three visits after discharge. Thirty patients were included, and 20 patients completed the three-month follow up. Results: There was a significant improvement in the following: forced expiratory flow in one second (L) (1.1/1.4/1.4; p = 0.019), six-minute walk test (m) (- /232.8 /272.6; p = 0.04), BODE score (7.5/5.0/3.8; p = 0.001), cognition measured by the Mini Mental State Examination (21/23.5/23.5; p = 0.008) and quality of life measured by the total Saint George Respiratory Questionnaire score (63.3/56.8/51, p = 0.02). The mean difference in the total score was 12.3 (between visits 1 and three). Important clinical differences were observed for the symptom score (18.8), activities score (5.2) and impact score (14.3). The majority of participants (80%) reported they would be willing to undergo a new intensive care unit admission. Conclusion: Despite the disease severity, there was a significant clinical, functional and quality of life improvement at the end of the third month. Most patients would be willing to undergo a new intensive care unit admission.

Influence of smoking cessation drugs on blood pressure and heart rate in patients with cardiovascular disease or high risk score: real life setting.

BACKGROUND: Smoking is the most important reversible cardiovascular risk factor. It is well established that quitting smoking reduces coronary events. However, on several occasions, the cardiovascular safety of smoking cessation drugs has been questioned. Our goal is to evaluate the effects of smoking cessation drugs on blood pressure and heart rate in patients from a smoking cessation service in a cardiology hospital. METHODS: We examined the PAF database (Smoking Cessation Assistance Program database) between January 2008 and March 2014. We analyzed data from 900 patients who were compliant with the treatment (50.5% male, average age 53 ± 17 years). The most frequent clinical diagnoses were coronary artery disease (25.2%), hypertension (57.2%), and diabetes (13.4%). Blood pressure, heart rate, and carbon monoxide (CO) concentration in exhaled air were analyzed at consecutive visits during the first 45 days of treatment (mean visits - 3). Analysis of repeated measures was used for the statistical analysis (p < 0.05). RESULTS: Two hundred seventy one patients used nicotine replacement therapy (NRT) alone, 81 used bupropion alone, 154 used varenicline alone, 283 used NRT plus bupropion and 111 used bupropion plus varenicline. For all smoking cessation drugs, used alone or in combination, no increase occurred in the average value of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). Significant reductions in CO concentrations occurred in all smoking cessation drug groups. CONCLUSION: Smoking cessation drugs used in monotherapy or in combined regimens did not influence systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in this group of patients during the observation period.

Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis C.

INTRODUCTION: Although it is standard procedure in the evaluation of liver diseases, biopsy is an invasive method subject to sampling error and intra or inter-observer variability. Thus, surrogate markers of liver fibrosis have been proposed, with variable availability and accuracy. AIM: Validate and compare the performance of APRI and FIB-4 as predictors of liver fibrosis in HCV patients. MATERIAL AND METHODS: Cross-sectional study including patients with HCV-RNA (+) who underwent liver biopsy. Significant fibrosis was defined as METAVIR stage ≥ 2. The diagnostic performance of the models in predicting significant fibrosis were evaluated and compared by ROC curves. RESULTS: The study included 119 patients, mean age 43.7 ± 10.6 years and 62% males. Significant fibrosis was identified in 41 patients. The AUROCs observed were: APRI = 0.793 ± 0.047, FIB-4 = 0.811 ± 0.045 and AST/ALT = 0.661 ± 0.055 (P = 0.054 for APRI vs. AST/ALT, and P = 0.014 for FIB-4 vs. AST/ALT). Considering classic cutoffs, the PPV and NPV for APRI and FIB-4 were, respectively, 77% and 92% and 83% and 81%. Thirteen (19%) patients were misdiagnosed by APRI and 16 (18%) by FIB-4. By restricting the indication of liver biopsy to patients with intermediate values, it could have been correctly avoided in 47% and 63% of the patients with APRI and FIB-4, respectively. CONCLUSION: The models APRI and FIB-4 were superior to AST/ALT ratio in the diagnosis of significant fibrosis in chronic HCV infection. Even though the overall performance of APRI and FIB-4 was similar, a higher proportion of patients may be correctly classified by FIB-4.

Artrite séptica pelo Haemophilus influenzae subtipo não b: relato de caso / Septic arthritis by Haemophilus influenzae not subtype b: case report

Haemophilus influenzae é um microorganismo responsávelpor uma variedade de infecções, sendo que namaioria das vezes são causadas pelo subtipo b. Relatamosum caso de artrite séptica pelo subtipo não b, associadoà meningite e piomiosite e sem evidência de fatorese condições predisponentes a infecção por esse agente.O paciente apresentou uma boa evolução clínica que foiatribuída a antibioticoterapia precoce e adequada.

Haemophilus influenzae is a microorganism responsiblefor a variety of infections, and most often are caused by subtypeb. We report a case of septic arthritis by subtype not b,associated with meningitis and pyomyositis and no evidenceof factors and conditions predisposing to infection by thispathogen. The patient had a clinical improvement was attributedto early and appropriate antibiotic therapy.

Smoking among patients hospitalized at a university hospital in the south of Brazil: prevalence, degree of nicotine dependence, and motivational stage of change.

OBJECTIVE: To determine the prevalence and profile of smoking among hospitalized patients at a university hospital in the south of Brazil. METHODS: This was a descriptive cross-sectional study involving patients over 18 years of age hospitalized for over 24 h at the Federal University of Santa Catarina University Hospital, located in the city of Florianópolis, Brazil. The patients were interviewed on two distinct occasions. We collected demographic data, socioeconomic data, and data regarding smoking. RESULTS: We interviewed 235 patients: 44 (18.7%) were smokers; 77 (32.8%) were former smokers; 114 (48.5%) were nonsmokers; and 109 (46.7%) were passive smokers. The mean age of the smokers was 45.7 ± 15.2 years, and 29 (65.9%) were male. Among the smokers, the median age at smoking initiation was 15 years; the mean smoking history was 32 ± 30.2 pack-years; 36 (81.9%) smoked up to 20 cigarettes/day; 20 (45.4%) had a high or very high degree of nicotine dependence; 32 (72.7%) had already tried to quit smoking; 39 (88.7%) would like to quit smoking; 32 (72.7%) would accept smoking cessation treatment; 13 (29.5%) smoked during hospitalization; and 13 (29.5%) suffered withdrawal syndrome. Regarding the motivation to quit smoking, the number of patients in the "preparation" and "action" stages of change increased from admission to discharge (from 31.8% to 54.8%). CONCLUSIONS: The prevalence of smoking in this study was similar to that reported in other studies conducted in Brazil. The results suggest that our sample was significant regarding the population of hospitalized smokers, who are motivated to quit smoking during hospitalization and require a systematized approach for doing so.

Tabagismo entre pacientes internados em um hospital universitário no sul do Brasil: prevalência, grau de dependência e estágio motivacional / Smoking among patients hospitalized at a university hospital in the south of Brazil: prevalence, degree of nicotine dependence, and motivational stage of change

OBJETIVO: Avaliar a prevalência e o perfil do tabagismo em pacientes internados em um hospital universitário no sul do Brasil. MÉTODOS: Estudo descritivo transversal com pacientes maiores de 18 anos hospitalizados há mais de 24 h no Hospital Universitário da Universidade de Santa Catarina em Florianópolis. Os pacientes foram entrevistados em duas ocasiões distintas. Dados demográficos, socioeconômicos e ligados ao tabagismo foram coletados. RESULTADOS: Foram entrevistados 235 pacientes: 44 (18,7 por cento) eram tabagistas; 77 (32,8 por cento) eram ex-tabagistas; 114 (48,5 por cento) eram não tabagistas e 109 (46,7 por cento) eram tabagistas passivos. A média de idade dos fumantes foi de 45,7 ± 15,2 anos, e 29 (65,9 por cento) eram do sexo masculino. Entre os fumantes, a mediana da idade de início do tabagismo foi de 15 anos; a carga tabágica média foi de 32 ± 30,2 anos-maço; 36 (81,9 por cento) tinham consumo diário de até 20 cigarros; 20 (45,4 por cento) tinham grau de dependência à nicotina elevada ou muito elevada; 32 (72,7 por cento) já haviam tentado cessar, 39 (88,6 por cento) gostariam de cessar, 32 (72,7 por cento) aceitariam receber tratamento, 13 (29,5 por cento) fumaram durante a internação, e 13 (29,5 por cento) apresentaram síndrome de abstinência. Houve um aumento no número de pacientes nos estágios motivacionais de preparação e ação durante a internação (de 31,8 por cento para 54,8 por cento). CONCLUSÕES: A prevalência de tabagismo no estudo foi semelhante à encontrada em outros estudos no Brasil. Os resultados sugerem que nossa amostra foi significativa em relação à população de fumantes hospitalizados, que se encontra motivada à cessação do hábito tabágico durante a hospitalização, necessitando de uma abordagem sistematizada para a cessação.

OBJECTIVE: To determine the prevalence and profile of smoking among hospitalized patients at a university hospital in the south of Brazil. METHODS: This was a descriptive cross-sectional study involving patients over 18 years of age hospitalized for over 24 h at the Federal University of Santa Catarina University Hospital, located in the city of Florianópolis, Brazil. The patients were interviewed on two distinct occasions. We collected demographic data, socioeconomic data, and data regarding smoking. RESULTS: We interviewed 235 patients: 44 (18.7 percent) were smokers; 77 (32.8 percent) were former smokers; 114 (48.5 percent) were nonsmokers; and 109 (46.7 percent) were passive smokers. The mean age of the smokers was 45.7 ± 15.2 years, and 29 (65.9 percent) were male. Among the smokers, the median age at smoking initiation was 15 years; the mean smoking history was 32 ± 30.2 pack-years; 36 (81.9 percent) smoked up to 20 cigarettes/day; 20 (45.4 percent) had a high or very high degree of nicotine dependence; 32 (72.7 percent) had already tried to quit smoking; 39 (88.7 percent) would like to quit smoking; 32 (72.7 percent) would accept smoking cessation treatment; 13 (29.5 percent) smoked during hospitalization; and 13 (29.5 percent) suffered withdrawal syndrome. Regarding the motivation to quit smoking, the number of patients in the "preparation" and "action" stages of change increased from admission to discharge (from 31.8 percent to 54.8 percent). CONCLUSIONS: The prevalence of smoking in this study was similar to that reported in other studies conducted in Brazil. The results suggest that our sample was significant regarding the population of hospitalized smokers, who are motivated to quit smoking during hospitalization and require a systematized approach for doing so.

Leptospirosis presenting as ascending progressive leg weakness and complicating with acute pancreatitis

Leptospirosis is a spirochetal bacterial infection of great public health importance. It has a broad spectrum of clinical manifestations which goes from subclinical infection and self-limited anicteric febrile illness (80-90 percent of all cases) to icteric leptospiropirosis known as Weil's disease. This is a severe disease characterized by hemorrhage, acute renal failure and jaundice. It is uncommon for leptospirosis to present itself as a primary neurological disease. Additionally, acute pancreatitis is an unusual gastrointestinal manifestation. We report a case of leptospirosis presenting as ascending progressive leg weakness and complicating with acute pancreatitis in an adult patient treated at Hospital Universitário, Universidade Federal de Santa Catarina. The diagnosis was confirmed through ELISA-IgM antibody testing positive for leptospirosis. After antibiotic therapy and support treatment for a few weeks, total resolution of severe manifestations was achieved. Rare and unusual presentations of leptospirosis should be kept in mind in relevant epidemiological scenario.

Leptospirosis presenting as ascending progressive leg weakness and complicating with acute pancreatitis.

Leptospirosis is a spirochetal bacterial infection of great public health importance. It has a broad spectrum of clinical manifestations which goes from subclinical infection and self-limited anicteric febrile illness (80-90% of all cases) to icteric leptospiropirosis known as Weil's disease. This is a severe disease characterized by hemorrhage, acute renal failure and jaundice. It is uncommon for leptospirosis to present itself as a primary neurological disease. Additionally, acute pancreatitis is an unusual gastrointestinal manifestation. We report a case of leptospirosis presenting as ascending progressive leg weakness and complicating with acute pancreatitis in an adult patient treated at Hospital Universitário, Universidade Federal de Santa Catarina. The diagnosis was confirmed through ELISA-IgM antibody testing positive for leptospirosis. After antibiotic therapy and support treatment for a few weeks, total resolution of severe manifestations was achieved. Rare and unusual presentations of leptospirosis should be kept in mind in relevant epidemiological scenario.

Frequência de internações por febre reumática em um hospital pediátrico de referência em um período de 20 anos / Frequency of admission of patients with rheumatic fever to a referral children's hospital during a 20-year period

OBJETIVO: Analisar a frequência de internações por febre reumática e as características dos pacientes portadores desta doença internados no Hospital Infantil Joana de Gusmão, Florianópolis (SC), entre 1986 e 2006. MÉTODOS: Estudo observacional, transversal, de eixo temporal, realizado por meio da análise dos prontuários médicos de pacientes com o diagnóstico, internados em 1986, 1991, 1996, 2001 e 2006. A coleta de dados incluiu faixa etária, sexo, evidência de estreptococcia prévia, manifestações clínicas (critérios revisados de Jones) e evolução. A análise foi descritiva. RESULTADOS: Nos anos analisados, houve 99 internações, sendo 59 em 1986, 17 em 1991, oito em 1996, 12 em 2001 e três em 2006. Predominou a faixa etária de cinco e 15 anos e 51 por cento da amostra era composta por meninos. Observou-se anticorpo antiestreptolisina O elevado em 54 por cento dos pacientes. Dentre as manifestações maiores de Jones, predominou a cardite (73 por cento), seguida de artrite (44 por cento) e coreia (14 por cento). Insuficiência mitral foi a valvopatia mais frequente e o percentual de insuficiência cardíaca congestiva nos casos com cardite diminuiu de 51 por cento (1986) para zero (2006). A reinternação por recidiva ocorreu em 31 por cento dos casos, com um óbito. CONCLUSÕES: Houve declínio expressivo do número de hospitalizações por febre reumática ao longo dos anos. A queda do percentual de insuficiência cardíaca congestiva sugere um perfil de menor gravidade dos casos. O alto número de recidivas aponta para possível falha na profilaxia secundária.

OBJECTIVE: To analyze the frequency of patients with rheumatic fever admitted to Joana de Gusmão Children's Hospital, in Florianopolis, in southern Brazil, and their characteristics, between 1986 and 2006. METHODS: This observational, cross-sectional, descriptive and temporal study included patients with rheumatic fever admitted to a referral hospital during 1986, 1991, 1996, 2001 and 2006. Their medical records were reviewed and the following data were collected: age, sex, evidence of previous estreptococcal infection, clinical manifestations (revised Jones criteria) and outcome. RESULTS: There were 99 hospital admissions: 59 in 1986, 17 in 1991, eight in 1996, 12 in 2001 and three in 2006. The age group between five and 15 years was predominant and 51 percent of the sample was composed of boys. Elevated levels of antistreptolysin O antibody were found in 54 percent of the patients. Regarding Jones major manifestations, carditis was very frequent (73 percent), followed by arthritis (44 percent) and chorea (14 percent). Mitral insufficiency was the most observed valve disease and the percentage of heart failure among patients with carditis declined from 51 percent (1986) to zero (2006). Readmissions due to recurrence occurred in 31 percent of the cases, with one death. CONCLUSIONS: There was an expressive decrease in the number of patients with rheumatic fever admitted to the referral hospital. The decline in the percentage of heart failure over years suggests a less severe profile of the cases in recent years. The high number of recurrences suggests failures in secondary prophylaxis.