Clinical and microbiological characteristics of bloodstream infections in a tertiary hospital in Maceió, Alagoas, Brazil.

We observed the clinical and microbiological characteristics of several stages of bloodstream infections (BSI), as well as the mortality attributed to it in a tertiary hospital in the northeast of Brazil (in the city of Maceió, Alagoas). A prospective cohort of 143 patients who had at least one positive blood culture was enrolled in the study. Their clinical evolution was followed up for 30 days from October 2005 to December 2006. The relation among the qualitative variables was verified through Chi-square test. The significance level was 5%. The statistical package adopted was SPSS 15.0 for Windows. Up to the thirtieth day, 30.1% of the patients presented bacteremia and 69.9% developed sepsis. Among these, 20.3% developed severe sepsis and 10.5% septic shock. The mortality attributed to it was 37.8%. In bacteremia, sepsis, severe sepsis, and septic shock conditions, mortality rates were 9.3%, 50%, 65.5%, and 84.6%, respectively. Respiratory (32.2%) and urinary (14%) sources and the ones related to central venous catheter (14%) were prevalent. In the wards 55.12% of the cases developed sepsis, whereas in the intensive care units, the rate was 87.69% (p < 0.05). Chronic renal failure, diabetes mellitus, and neuropathy were present in 21.7%, 26.6%, and 29.4% of the cases, respectively. Coagulase-negative Staphylococcus (25.9%), Staphylococcus aureus (21%), and Klebsiella pneumoniae (14%) were the most present microorganism in the sample. The high morbidity and mortality rates in this study are attributed to the lack of knowledge on BSI characteristics and on instituted protocols for detection and treatment in early stages.

Clinical and microbiological characteristics of bloodstream infections in a tertiary hospital in Maceió, Alagoas, Brazil

We observed the clinical and microbiological characteristics of several stages of bloodstream infections (BSI), as well as the mortality attributed to it in a tertiary hospital in the northeast of Brazil (in the city of Maceió, Alagoas). A prospective cohort of 143 patients who had at least one positive blood culture was enrolled in the study. Their clinical evolution was followed up for 30 days from October 2005 to December 2006. The relation among the qualitative variables was verified through Chi-square test. The significance level was 5 percent. The statistical package adopted was SPSS 15.0 for Windows. Up to the thirtieth day, 30.1 percent of the patients presented bacteremia and 69.9 percent developed sepsis.Among these, 20.3 percent developed severe sepsis and 10.5 percent septic shock. The mortality attributed to it was 37.8 percent. In bacteremia, sepsis, severe sepsis, and septic shock conditions, mortality rates were 9.3 percent, 50 percent, 65.5 percent, and 84.6 percent, respectively. Respiratory (32.2 percent) and urinary (14 percent) sources and the ones related to central venous catheter (14 percent) were prevalent. In the wards 55.12 percent of the cases developed sepsis, whereas in the intensive care units, the rate was 87.69 percent (p < 0.05). Chronic renal failure, diabetes melitus, and neuropathy were present in 21.7 percent, 26.6 percent, and 29.4 percent of the cases, respectively. Coagulase-negative Staphylococcus (25.9 percent), Staphylococcus aureus (21 percent), and Klebsiella pneumoniae (14 percent) were the most present microorganism in the sample. The high morbidity and mortality rates in this study are attributed to the lack of knowledge on BSI characteristics and on instituted protocols for detection and treatment in early stages.

Effect of theophylline associated with short-acting or long-acting inhaled beta2-agonists in patients with stable chronic obstructive pulmonary disease: a systematic review.

OBJECTIVES: To determine whether, in stable patients with chronic obstructive pulmonary disease, administration of theophylline in combination with short-acting or long-acting inhaled beta2-agonists is more efficacious than is a placebo or each of these drugs used in isolation. METHODS: A systematic review and meta-analysis were carried out. All randomized and double-blind clinical trials found in the literature were selected. RESULTS: A total of eight studies were included. In comparing the effect of theophylline combined with beta2-agonists to that of a placebo, we found a statistically significant improvement in mean FEV1 (0.27 L; 95% CI: 0.11 to 0.43) and mean dyspnea (-0.78; 95% CI: -1.26 to -0.29). None of the meta-analyses performed detected any difference between the results obtained using theophylline combined with beta2-agonists and those obtained using beta2-agonists alone. When the administration of theophylline combined with beta2-agonists was compared to that of theophylline alone, there was a statistically significant improvement in mean dyspnea (-0.19; 95% CI: -0.34 to 0.04). CONCLUSION: In patients with stable chronic obstructive pulmonary disease, theophylline combined with beta2 agonists is more efficacious than is a placebo in terms of improving FEV1 and dyspnea. In addition, theophylline combined with beta2 agonists is more efficacious than is theophylline in improving dyspnea. Furthermore, administration of theophylline combined with beta2 agonists is no more efficacious, for any of the variables studied, than is the use of beta2-agonists in isolation.

Epidemiologia das infecções da corrente sanguínea / Bloodstream infections epidemiology

As infecções da corrente sangüínea (ICS) são patologias graves que afetam, principalmente, pacientes criticamente enfermos internados em Unidades de Terapia Intensiva (UTI) e submetidos a procedimentos invasivos, entre eles cateter venoso central (CVC). Os dados mais relevantes, na maioria dos trabalhos revisados neste estudo foram: a incidência de sepse na ordem de 1,3 por cento, o aumento anual da taxa de incidência de 8,9 por cento, a inversão do predomínio de Gram-negativos para Gram-positivos, a diminuição da mortalidade e o aumento na incidência de disfunção orgânica ao longo dos anos. A taxa de ocorrência de sepse grave variou de 0,26 por cento, em pacientes de enfermaria, a 27 por cento, em pacientes de UTI e a taxa de mortalidade por sepse ocorreu em torno de 30 por cento. Os principais responsáveis pelas ICS foram: as condições do hospedeiro, os fatores microbiológicos, terapêuticos e ambientais. A uniformização dos conceitos mostrou-se essencial para a comparabilidade dos estudos científicos e o estabelecimento do perfil epidemiológico das ICS

Efeito da teofilina associada ao beta2-agonista inalatório de curta ou longa duração, em pacientes com doença pulmonar obstrutiva crônica estável: revisão sistemática / Effect of theophylline associated with short-acting or long-acting inhaled beta2-agonists in patients with stable chronic obstructive pulmonary disease: a systematic review

OBJETIVOS: Avaliar se o tratamento com teofilina associada ao beta2-agonista inalatório de curta ou longa duração é mais eficaz que o placebo e que o uso isolado de cada um dos fármacos, para os pacientes com doença pulmonar obstrutiva crônica estável. MÉTODOS: Realizou-se uma revisão sistemática com metanálise, sendo selecionados todos os ensaios clínicos aleatórios e duplo-cegos encontrados na literatura. RESULTADOS: Foram incluídos oito estudos. Teofilina associada ao beta2-agonista vs. placebo: houve melhora estatisticamente significante para o VEF1 (L), com média 0,27 (IC95 por cento 0,11 a 0,43); e para a dispnéia, com média -0,78 (IC95 por cento -1,26 a -0,29). Teofilina associada ao beta2-agonista vs. beta2-agonista isolado: nenhuma das metanálises realizadas detectou diferença entre os grupos. Teofilina associada ao beta2-agonista vs. teofilina isolada: houve melhora estatisticamente significante para a dispnéia, com média -0,19 (IC95 por cento -0,34 a -0,04). CONCLUSÕES: Em pacientes com doença pulmonar obstrutiva crônica estável: 1) teofilina associada ao beta2-agonista é mais eficaz que o placebo, em relação ao VEF1 e dispnéia; 2a) teofilina associada ao beta2-agonista é mais eficaz que a teofilina isolada, em relação à dispnéia; e 2b) teofilina associada ao beta2-agonista não é mais eficaz que o beta2-agonista isolado, para quaisquer das variáveis estudadas.

OBJECTIVES: To determine whether, in stable patients with chronic obstructive pulmonary disease, administration of theophylline in combination with short-acting or long-acting inhaled beta2-agonists is more efficacious than is a placebo or each of these drugs used in isolation. METHODS: A systematic review and meta-analysis were carried out. All randomized and double-blind clinical trials found in the literature were selected. RESULTS: A total of eight studies were included. In comparing the effect of theophylline combined with beta2-agonists to that of a placebo, we found a statistically significant improvement in mean FEV1 (0.27 L; 95 percentCI: 0.11 to 0.43) and mean dyspnea (-0.78; 95 percentCI: -1.26 to -0.29). None of the meta-analyses performed detected any difference between the results obtained using theophylline combined with beta2-agonists and those obtained using beta2-agonists alone. When the administration of theophylline combined with beta2-agonists was compared to that of theophylline alone, there was a statistically significant improvement in mean dyspnea (-0.19; 95 percentCI: -0.34 to 0.04). CONCLUSION: In patients with stable chronic obstructive pulmonary disease, theophylline combined with beta2 agonists is more efficacious than is a placebo in terms of improving FEV1 and dyspnea. In addition, theophylline combined with beta2 agonists is more efficacious than is theophylline in improving dyspnea. Furthermore, administration of theophylline combined with beta2 agonists is no more efficacious, for any of the variables studied, than is the use of beta2-agonists in isolation.

Air pollution effects on myocardial infarction.

OBJECTIVE: Myocardial infarction is an acute and severe cardiovascular disease that generally leads to patient admissions to intensive care units and few cases are initially admitted to infirmaries. The objective of the study was to assess whether estimates of air pollution effects on myocardial infarction morbidity are modified by the source of health information. METHODS: The study was carried out in hospitals of the Brazilian Health System in the city of São Paulo, Southern Brazil. A time series study (1998-1999) was performed using two outcomes: infarction admissions to infirmaries and to intensive care units, both for people older than 64 years of age. Generalized linear models controlling for seasonality (long and short-term trends) and weather were used. The eight-day cumulative effects of air pollutants were assessed using third degree polynomial distributed lag models. RESULTS: Almost 70% of daily hospital admissions due to myocardial infarction were to infirmaries. Despite that, the effects of air pollutants on infarction were higher for intensive care units admissions. All pollutants were positively associated with the study outcomes but SO2 presented the strongest statistically significant association. An interquartile range increase on SO2 concentration was associated with increases of 13% (95% CI: 6-19) and 8% (95% CI: 2-13) of intensive care units and infirmary infarction admissions, respectively. CONCLUSIONS: It may be assumed there is a misclassification of myocardial infarction admissions to infirmaries leading to overestimation. Also, despite the absolute number of events, admissions to intensive care units data provides a more adequate estimate of the magnitude of air pollution effects on infarction admissions.

Air pollution effects on myocardial infarction

OBJETIVO: O infarto do miocárdio é uma doença cardiovascular grave que tem como indicação a internação em unidades de terapia intensiva, com poucos indicados para admissão em enfermarias. O objetivo do estudo foi investigar se as estimativas dos efeitos da poluição atmosférica nas internações por infarto do miocárdio são modificadas de acordo com a fonte de informações de saúde. MÉTODOS: Em hospitais do Sistema Unico de Saúde (SUS), na cidade de São Paulo, foi realizado estudo de séries temporais (1998-1999) tendo como desfechos as internações por infarto em unidades de terapia intensiva e em enfermarias, em pessoas acima de 64 anos. Foram utilizados modelos lineares generalizados, controlados para sazonalidade (de longa e curta duração) e variáveis climáticas. Foram construídos modelos distribuídos de defasagem polinomial de terceiro grau, para avaliar os efeitos acumulados nos oito dias anteriores à exposição.RESULTADOS: Aproximadamente 70 por cento das internações por infarto no miocárdio ocorreram em enfermarias. Apesar disso, os efeitos da poluição sobre os casos foram maiores nas internações em unidades de terapia intensiva. Todos os poluentes mostraram uma associação positiva com os desfechos, mas o SO2 apresentou uma associação mais robusta e estatisticamente significante. O aumento do intervalo interquartil para as concentrações observadas do SO2 foi associado ao aumento em 13 por cento (IC 95 por cento: 6-19) e 8por cento (IC 95por cento: 2-13) nas internações em unidade de terapia intensiva e enfermarias, respectivamente. CONCLUSÕES: Pode-se supor que exista um erro de classificação das internações por infarto nas enfermarias, superestimando o número de internações. No entanto, o menor número de internações por infarto do miocárdio em unidades de terapia intensiva, é o indicador mais adequado para estimar os efeitos da poluição atmosférica nas internações por infarto.

Alternative strategies for exercise critical power estimation in patients with COPD.

Exercise critical power (CP) has been shown to represent the highest sustainable work rate (WR) in patients with chronic obstructive pulmonary disease (COPD). Parameter estimation, however, depends on 4 high-intensity tests performed, on different days, to the limit of tolerance (T(lim)). In order to establish a milder protocol that would be more suitable for disabled patients, we contrasted CP derived from 4, 3 and 2 tests (CP4, CP3 and CP2) in 8 males with moderate COPD. In addition, CP was calculated from 2 single-day tests performed on an inverse sequence (CP(2AB) and CP(2BA)): CP values within 5 W from CP4 were assumed as "clinically-acceptable" estimates. We found that [CP4-CP3] and [CP4-CP2] differences were within 5 W in 8 and 6 patients, respectively (95% confidence interval of the differences = -1.3 to 3.5 W and -11.5 to 6.5 W). There was a systematic decline on T(lim) when an exercise bout was performed after a previous test on the same day (P<0.05). Consequently, substantial differences were found between CP4 and any of the CP estimates obtained from single-day tests. In conclusion, clinically-acceptable estimates of CP can be obtained by using 3 or, in most circumstances, 2 constant WR tests in patients with moderate COPD--provided that they are not performed on the same day.

Metabolic and ventilatory parameters of four activities of daily living accomplished with arms in COPD patients.

STUDY OBJECTIVE: The upper limbs are involved in the activities of daily living (ADLs). Normal subjects usually perform such activities without noticing the energy cost, but patients with COPD report tiredness when performing them. This study was designed to assess the metabolic and ventilatory demands in patients with COPD during the performance of four ADLs involving the upper limbs. DESIGN: The patients were tested on two different days. Oxygen uptake (O(2)), carbon dioxide output (CO(2)), minute ventilation (E), and heart rate were measured while performing four ADLs for 5 min each: sweeping, erasing a blackboard, lifting pots, and replacing lamps. PARTICIPANTS: Ten normal, young, male subjects (mean age, 27.9 years) were selected for testing the reproducibility of the methods, and 9 male patients with COPD (FEV(1), 32.5%; mean age, 58.9 years) entered the study. MEASUREMENTS AND RESULTS: The tests were reproducible for both groups. Patients with COPD presented a significant increase (p < 0.05) in O(2) (mean, 50.2% of maximum O(2)) and in E (mean, 55.7% of maximum voluntary ventilation [MVV]) in relation to initial resting conditions for all four activities. CONCLUSIONS: We conclude that when performing these four activities, patients with moderate-to-severe COPD present a high O(2), which may explain the tiredness reported by them during simple activities involving the upper limbs; the high E/MVV may be associated to dyspnea.