Factors associated with delirium in critical patients in a health institution in Bucaramanga, Colombia. / Factores asociados con el delírium en pacientes críticos de una institución de salud de Bucaramanga, Colombia.

OBJECTIVE: To determine the incidence and the factors associated with delirium in intensive care unit patients. METHODS: A cohort study conducted on 134 patients in the intensive care unit at a clinic in Bucaramanga, Colombia., who were recruited in the first 24hours following admission and on whom the Richmond Agitation-Sedation Scale (RASS), PRE-DELIRIC version in Spanish, and Confusion Assessment method for Intensive Care Unit (CAM-ICU) were applied; the outcome was evaluated through daily monitoring with CAM-ICU. RESULTS: The incidence of delirium was 20.2%, the predominating type was hypoactive at 66.7%, followed by the hyperactive type at 7.4% and mixed at 25.9%. Fifty-two percent of the patients with delirium died. In the bivariate analysis, the use of sedatives (Relative Risk(RR) 2.4, 95% confidence interval (95% CI) = 1.2-4.5), infection (RR = 2. 8, 95% CI=1.3-5.9), metabolic acidosis (RR = 4 3, 95% CI=2.3-8.0), mechanical ventilation (RR = 4 6, 95% CI=2.0-10.6), aged over 60 years (RR = 2 3, 95% CI=1.09-5.3) and APACHE score greater than 14 (RR = 3. 0) (95% CI=1.1-8.2) were identified as risk factors for delirium. The multivariate analysis only found a relationship with infection (RR = 3 8, 95% CI=1.6-9.1) and being aged over 60 years (RR = 3 2, 95% CI 1.2-8.3). CONCLUSIONS: delirium is frequent in patients in the intensive care unit, especially the hypoactive type. Half of the patients with delirium died. The main risk factors for delirium are infection and being over 60 years age, therefore, delirium prevention activities should focus on these critical patients.

Prevalence of pyrazinamide resistance and Wayne assay performance analysis in a tuberculosis cohort in Lima, Peru.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) regimens often contain pyrazinamide (PZA) even if susceptibility to the drug has not been confirmed. This gap is due to the limited availability and reliability of PZA susceptibility testing. OBJECTIVES: To estimate the prevalence of PZA resistance using the Wayne assay among TB patients in Lima, Peru, to describe characteristics associated with PZA resistance and to compare the performance of Wayne with that of BACTEC™ MGIT™ 960. METHODS: PZA susceptibility using the Wayne assay was tested in patients diagnosed with culture-positive pulmonary TB from September 2009 to August 2012. Factors associated with PZA resistance were evaluated. We compared the performance of the Wayne assay to that of MGIT 960 in a convenience sample. RESULTS: The prevalence of PZA resistance was 6.6% (95%CI 5.8-7.5) among 3277 patients, and 47.7% (95%CI 42.7-52.6) among a subset of 405 MDR-TB patients. In multivariable analysis, MDR-TB (OR 86.0, 95%CI 54.0-136.9) and Latin American-Mediterranean lineage (OR 3.40, 95%CI 2.33-4.96) were associated with PZA resistance. The Wayne assay was in agreement with MGIT 960 in 83.9% of samples (κ 0.66, 95%CI 0.56-0.76). CONCLUSION: PZA resistance was detected using the Wayne assay in nearly half of MDR-TB patients in Lima. This test can inform the selection and composition of regimens, especially those dependent on additional resistance.

Impact of rapid drug susceptibility testing for tuberculosis: program experience in Lima, Peru.

SETTING: Programmatic implementation of decentralized rapid drug susceptibility testing (DST) in Lima, Peru. OBJECTIVE: Pre-post analysis compared time to diagnosis, treatment outcome and survival among patients tested with direct nitrate reductase assay (NRA) vs. indirect conventional methods. DESIGN: From 2005 to 2009, we prospectively followed all patients referred for DST before (control) and after (intervention) NRA implementation. Among those referred for DST, NRA was used for smear-positive samples of patients with no prior history of multidrug resistance or treatment for multidrug-resistant tuberculosis (TB). Data were abstracted from patient charts and laboratory registers. Endpoints were favorable outcomes, time to result and time to death. RESULTS: Of those patients who met the criteria for NRA, 740 underwent NRA and 621 underwent conventional DST. NRA yielded test results for 78.4% of cases vs. 68.8% for conventional DST (P < 0.0001); the median time to result was 44 vs. 133 days, respectively (adjusted HR 0.64, 95%CI 0.56-0.73). Among individuals without previous anti-tuberculosis treatment, NRA was associated with a favorable treatment outcome (adjusted OR 1.39, 95%CI 1.01-1.90) and prolonged survival (adjusted HR 0.53, 95%CI 0.31-0.90). CONCLUSION: Direct NRA significantly shortened time to test result and improved treatment outcomes and survival in certain groups.

Propriedades da carne e perfil de ácidos graxos do pernil de catetos (Tayassu tajacu) alimentados com torta de babaçu (Orbignya phalerata) / Meat properties and fatty acids profile of the ham of peccaries (Tayassu tajacu) fed babassu (Orbignya phalerata) meal

Analisaram-se as propriedades da carne e o perfil de ácidos graxos do pernil de catetos alimentados com dietas contendo diferentes porcentagens de torta de babaçu, usada como fonte energética alternativa substituindo parte do milho na alimentação, em sistemas de produção em cativeiro. Avaliou-se o pernil de 12 animais quanto às suas propriedades - perda de peso ao cozimento, força de cisalhamento, pH e capacidade de retenção de água-, depois extraiu-se o óleo da carne e determinou-se o perfil dos ácidos graxos. Não foram observados efeitos (P>0,05) das porcentagens de torta de babaçu sobre as propriedades da carne; os ácidos graxos (AG) insaturados, mono e poli-insaturados, foram encontrados em maior quantidade (51,6-57,8 por cento) que os ácidos graxos saturados (42,2-48,4 por cento) na carne do pernil. Baseando-se na teoria de que os AG poli-insaturados ingeridos na dieta humana são responsáveis pela redução nos níveis séricos de colesterol, sugere-se que a carne de catetos seja uma boa fonte alternativa de proteína.

The meat properties and the fatty acids profile of the ham of peccaries ham fed diets with different levels of babassu meal, used as an alternative energy source substituting part of corn on feeding peccaries in captivity, were studied. The ham meats of 12 animals were evaluated on their properties: cooking losses, shear force, pH, and water holding capacity. After that, the meat oil was extracted to determine the fatty acids contents. No effects (P>0.05) of the babassu meal levels on the meat properties were observed. The unsaturated fatty acids, mono and polyunsaturated, were found in higher quantity than the saturated fatty acids in the ham meat of peccaries. Based on the theory that the polyunsaturated fatty acids ingested in the human diet are responsible for reduction of the seric levels of cholesterol, it can be suggested that the peccary meat is a good alternative source of protein.

Electrical stunning, hot boning, and quality of chicken breast meat.

The first experiment was conducted to determine the effects of varying voltage, 20, 40, 80, and 100 V at 60 Hz, on stunning efficiency, blood loss, and carcass defects. In the second experiment, the same parameters were evaluated to determine the effects of varying frequency, 60, 200, 350, 500, and 1,000 Hz at 40 V. A control group for both experiments was not stunned. At 40V, 30 to 50 mA, 90% of the birds were unconscious, as shown by no response to comb piercing, and blood loss was maximized (55.3%). When varying the stunning frequency, maximum blood loss (73.1%), 90% of the birds were unconscious, and minimum carcass defects were observed at 1,000 Hz, 40 V. In the third experiment, birds were stunned at 40 V, 1,000 Hz and deboned immediately after defeathering (hot boning) and chilled or deboned after passing through all stages of a commercial abattoir operation (conventional boning). Control lots were unstunned and followed normal abattoir stages. Average shear value was significantly lower for stunned compared to unstunned birds (6.0 vs. 7.1 kg/g), although tenderness scores, as measured by a trained panel, were not significantly different (6.6 for stunned birds vs. 6.1 for unstunned). Scores for juiciness were also not significantly different (5.5 for stunned vs. 5.8 for unstunned). Average shear value was also significantly lower for conventionally boned birds (5.2 kg/g) than for hot boned birds (7.9 kg/g). Sensory analysis confirmed the shear value results. Conventionally boned breasts had an average tenderness score of 7.4 vs. an average of 5.3 for hot boned breast. No statistical differences were observed with respect to juiciness, although a score of 6.2 was observed for conventionally boned breast meat vs. a score of 5.1 for hot boned breast meat.

Hypoglycemic activity of root water decoction, sesquiterpenoids, and one polysaccharide fraction from Psacalium decompositum in mice.

The hypoglycemic activity of Psacalium decompositum (Asteraceae) was investigated in fasting healthy mice and alloxan-diabetic mice. The freeze-dried water decoction significantly reduced the blood glucose in normal mice (from 50.9 +/- 4.7 to 32.5 +/- 3.1 mg/dl) and in mild diabetic mice (from 208.5 +/- 13.0 to 52.3 +/- 7.0 mg/dl), 240 min after intraperitoneal administration (P < 0.005). This preparation also diminished fasting glycemia in severe diabetic mice, but the effects were minor (from 394.4 +/- 9.4 to 289.3 +/- 39.5 mg/dl). The main sesquiterpenoid constituents from P. decompositum roots, cacalol, cacalone and maturin, as well as the transformation product cacalol acetate, did not show a hypoglycemic effect on healthy mice. Nevertheless, two polysaccharide fractions (F1 and F3) obtained from the freeze-dried water extract significantly reduced the fasting glycemia in healthy mice. The best results were obtained with the F1 fraction.