Evidências iniciais de validade da escala de liderança virtuosa / Initial validity evidence of the Virtuous Leadership Scale

O estudo objetivou reunir evidências iniciais de validade no contexto brasileiro para a Escala de Liderança Virtuosa. Participaram do estudo 417 trabalhadores de ambos os sexos (63% do sexo masculino), do estado do Rio de Janeiro. As idades variaram de 18 a 72 anos (M = 35,6; DP = 10,43). A análise fatorial confirmatória evidenciou que a versão brasileira da escala apresentou validade de estrutura interna. A Escala foi composta por cinco fatores de primeira ordem (coragem, prudência, temperança, humanidade e justiça), distribuídos por 18 itens que reproduziram integralmente a estrutura original do instrumento. Todas as subescalas apresentaram correlações positivas com a liderança autêntica, a satisfação no trabalho e os afetos positivos, e negativas com os afetos negativos. Conclui-se que a Escala de Liderança Virtuosa apresentou boas qualidades psicométricas em uma amostra brasileira.

The aim of the study was to collect initial validity evidence of the Virtuous Leadership Scale in the Brazilian context. A total of 417 workers of both sexes (63% male) from the State of Rio de Janeiro participated in the study. The ages ranged from 18 to 72 years (M = 35.6, SD = 10.43). Confirmatory factor analysis showed that the Brazilian version of the scale presented internal structure validity and it was composed of five first-order factors (courage, prudence, temperance, humanity and justice). The 18 items replicate the original structure of the instrument. All subscales showed positive correlations with authentic leadership, job satisfaction and positive effects, and negative correlations with negative effects. It was concluded that the Virtuous Leadership Scale presented good psychometric qualities in the Brazilian sample.

Asma grave em pacientes adultos e pediátricos: Protocolo da Sociedade Mineira de Pneumologia e Cirurgia Torácica (SMPCT) - 2019 / Severe asthma in adult and pediatric patients: Protocol of the Sociedade Mineira de Pneumologia e Cirurgia Torácica (SMPCT) - 2019

Este documento é uma revisão do protocolo de asma grave da SMPCT de 2015, que se fez necessária devido à atualização de avanços em pesquisas, principalmente em fenotipagem/genotipagem e terapêutica da asma grave, além de asma grave na pediatria. A maioria da publicações relata que 5% a 10% dos asmáticos podem apresentar asma grave. Porém, levantamento na Holanda encontrou uma prevalência menor, de 3,6% ou 10,4/10000 habitantes, que parece ser mais próximo da realidade. Este protocolo tem como população alvo os pacientes com asma grave, adultos e pediátricos, conforme definições de asma grave da"International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma" de 2014 e GINA 2018.1,3 Seus potenciais utilizadores são especialistas em doenças respiratórias que lidam com asma grave, e que devem ser os responsáveis pela aplicação do protocolo, e também clínicos gerais, pediatras, médicos de cuidados primários, enfermeiros, fisioterapeutas e outros profissionais da saúde. É aconselhável consulta com um especialista em asma nos seguintes casos: asma de difícil diagnóstico, suspeita de asma ocupacional, asma persistente não controlada com exacerbações frequentes, asma com risco de morte, eventos adversos significativos ou suspeita de subtipos de asma grave.4 Este documento não tem a intenção de instituir um tratamento padronizado, mas estabelecer bases racionais para decisões em pacientes com asma grave, pois as recomendações não conseguem abranger toda a complexidade do julgamento clínico em casos individuais. Os autores recomendam sua revisão e atualização no período máximo de 3 anos, ou, se necessário, em tempo menor.

Ritidoplastia com tunelização associada a lipoaspiração e descolamento reduzido / Rhytidectomy with tunneling combined with liposuction and reduced detachment

Introdução: Várias técnicas de rejuvenescimento facial buscam encontrar resultados satisfatórios com mínimas complicações. Com a introdução da lipoaspiração, a cirurgia da face teve um grande benefício na região cervical. O objetivo deste estudo é demonstrar a técnica de tunelização associada a lipoaspiração prévia e descolamento reduzido da face e plicatura do SMAS/ platisma para tratamento do envelhecimento facial. Métodos: Foram analisados retrospectivamente os resultados obtidos com 129 pacientes operados entre 2005 e 2015, com a tática cirúrgica proposta, aqui demonstrada. Resultados: Os pacientes apresentaram boa satisfação com a tática cirúrgica utilizada, baixo índice de complicações e retorno rápido ao trabalho. Conclusões: A ritidoplastia com tunelização associada a lipoaspiração e descolamento seletivo é efetiva, com boa mobilidade e segurança do retalho cutâneo suprajacente, reprodutível, sendo uma opção no tratamento do envelhecimento facial.

Introduction: Multiple facial rejuvenation techniques have been used to obtain satisfactory results with minimal complications. With the introduction of liposuction for facial surgery, treatment of the cervical region has improved. This study aimed to describe a technique using preceding liposuction combined with reduced detachment and plication of the superficial muscular aponeurotic system/platysma for treatment of facial aging. Methods: We retrospectively analyzed the results in 129 patients who underwent surgery between 2005 and 2015. Results: The patients reported satisfaction with the surgical technique, a low complication rate, and early return to work. Conclusions: Rhytidectomy with tunneling combined with liposuction and selective detachment is effective, with good mobility of the overlying skin flap; the technique is safe and reproducible, and is an option for the treatment of facial aging.

The Exercise of Autonomy by Older Cancer Patients in Palliative Care: The Biotechnoscientific and Biopolitical Paradigms and the Bioethics of Protection.

Toward the end of life, older cancer patients with terminal illness often prefer palliative over life-extending care and also prefer to die at home. However, care planning is not always consistent with patients' preferences. In this article, discussions will be centered on patients' autonomy of exercising control over their bodies within the current biotechnoscientific paradigm and in the context of population aging. More specifically, the biopolitical strategy of medicine in the context of hospital-centered health care control and of the frail condition of cancer patients in the intensive care unit will be considered in terms of the bioethics of protection. This ethical principle may provide support to these patients by ensuring that they receive appropriate treatment of pain and other physical, psychosocial, and spiritual problems in an attempt to focus attention on the values of the ill person rather than limiting it to the illness.

Atuais diretrizes do rastreamento do câncer colorretal: revisão de literatura / Current guidelines for screening colorectal cancer: a review of the literature

O câncer colorretal (CCR) é atualmente considerado uma neoplasia com alta taxa de incidência e de mortalidade na população, sendo o terceiro tipo de câncer mais prevalente no mundo e a segunda causa de mortes por câncer. Devido à importância de amenizar estas taxas, foram avaliados diversos métodos existentes nos Estados Unidos, na Europa e no Brasil para o rastreio do câncer colorretal, sendo notável a variedade de opções de exames disponíveis, além dos fatores de risco mundialmente difundidos. Foi observado que a mudança do estilo de vida é de difícil adesão, tornando assim imprescindível a adoção de um método de rastreio eficaz para detecção precoce e remoção de lesões pré-malignas e de neoplasias em estágio inicial, visando reduzir a incidência e a mortalidade do CCR e os gastos despendidos com o tratamento no caso de uma neoplasia avançada. No entanto, ainda não há um consenso acerca de um método de rastreio altamente qualificado e utilizado mundialmente de maneira unânime (AU)

Colorectal cancer (CRC) is currently considered a neoplasm with a high rate of incidence and mortality in the population, being the third most prevalent type of cancer in the world and the second cause of cancer deaths. Due to the importance of mitigating these rates, several methods for the screening of colorectal cancer used in the United States, Europe and Brazil were assessed, being noteworthy the variety of options for tests available, in addition to the risk factors broadcast worldwide. It has been observed that lifestyle changes are difficult to implement, thus making it imperative to adopt an effective screening method for the early detection and removal of premalignant lesions and early stage neoplasms in order to reduce the incidence and mortality of CRC and the costs incurred with treatment in case of advanced neoplasia. However, there is as yet no consensus on a highly qualified screening method used universally worldwide (AU)

Course of functional status in elderly patients after coronary artery bypass surgery: 6-month follow up.

AIM: To determine longitudinal changes in functional status using three functional assessment scales in elderly patients undergoing coronary artery bypass grafting. METHODS: This was a prospective observational cohort study of 73 patients aged ≥60 years undergoing elective coronary artery bypass grafting. Patients were assessed for functional status before admission, at hospital discharge, and at 1 and 6 months after discharge using the Functional Independence Measure, Katz Activities of Daily Living scale, and Lawton Instrumental Activities of Daily Living scale. Data were stratified by age (≥70 years and <70 years) and complications (with and without) for analysis. RESULTS: In patients aged ≥70 years (n = 38), Functional Independence Measure scores ranged from 121.30 ± 6.42 (pre-admission) to 112.10 ± 17.10 (1 month) and 117.80 ± 13.50 (6 months), Katz scores from 5.88 ± 0.32 (pre-admission) to 5.45 ± 1.04 (1 month) and 5.83 ± 0.65 (6 months), and Lawton scores from 25.40 ± 3.30 (pre-admission) to 20.05 ± 4.93 (1 month) and 24.50 ± 4.10 (6 months; P < 0.001 for all). No significant changes were found in scale scores over time between groups with (n = 34) and without (n = 39) complications. When groups aged ≥70 years (n = 38) and <70 (n = 35) were compared, Functional Independence Measure scores showed a difference toward recovery over time in older patients (discharge - pre-admission, P = 0.010; 1 month - pre-admission, P = 0.0004; and 6 months - pre-admission, P = 0.079). CONCLUSIONS: The Functional Independence Measure was able to detect significant functional loss over a 6-month period in elderly patients undergoing coronary artery bypass grafting, suggesting that this scale is a promising tool for the assessment of functional recovery over time after cardiac surgery, especially in patients aged older than 70 years. Geriatr Gerontol Int 2015; ●●: ●●-●●.

Delayed medical emergency team calls and associated outcomes.

OBJECTIVE: To determine whether there was an association between delayed medical emergency team calls and mortality after a medical emergency team review. DESIGN: This was a prospective observational study. SETTING: A university-affiliated tertiary referral hospital in Porto Alegre, Brazil. PATIENTS: All patients were reviewed by the medical emergency team from July 2008 to December 2009. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 1,481 calls for 1,148 patients. Delayed medical emergency team calls occurred for 246 patients (21.4%). The criterion associated with delay was typically the same criterion for the subsequent medical emergency team call. Physicians had a greater prevalence of delayed medical emergency team calls (110 of 246 [44.7%]) than timely medical emergency team calls (267 of 902 [29.6%]; p < 0.001). The mortality at 30 days after medical emergency team review was higher among patients with delayed medical emergency team activation (152 [61.8%]) than patients receiving timely medical emergency team activation (378 [41.9%]; p < 0.001). In a multivariate analysis, delayed medical emergency team calls remained significantly associated with higher mortality. CONCLUSIONS: Delayed medical emergency team calls are common and are independently associated with higher mortality. This result reaffirms the concept and need for a rapid response system.

Eficácia a curto prazo do laser de baixa intensidade em pacientes com osteoartrite do joelho: ensaio clínico aleatório, placebo-controlado e duplo-cego / Short-term efficacy of low-level laser therapy in patients with knee osteoarthritis: a randomized placebo-controlled, double-blind clinical trial

OBJETIVO: Este estudo foi designado para avaliar a eficácia a curto prazo da laserterapia de baixa intensidade (LBI) na melhora da dor e função em pacientes portadores de osteoartrite (OA) do joelho. MÉTODOS: Participaram deste ensaio clínico aleatório, duplo-cego e controlado 47 pacientes (79 joelhos) de ambos os sexos portadores de OA do joelho, que foram distribuídos aleatoriamente em dois grupos; grupo laser com 25 pacientes (41 joelhos) e grupo placebo com 22 pacientes (38 joelhos). A LBI foi realizada três vezes por semana totalizando nove sessões, com uso do laser AsGa de 904nm, 60mW de potência média e 0,5cm² de área do feixe, sendo irradiados nove pontos no joelho com energia de 3,0J por ponto. O grupo placebo foi tratado com o mesmo aparelho de laser, porém com uma caneta selada. As avaliações Lequesne, escala visual numérica (EVN), Timed Up and Go (TUG), goniometria e dinamometria foram realizadas antes do início do tratamento e após as nove sessões da LBI. RESULTADOS: Foi encontrada melhora significante da dor e função para todas as avaliações aplicadas no grupo laser. Quando comparado o grupo laser ao grupo placebo encontrou-se diferença significante para as avaliações EVN-Repouso e Lequesne. CONCLUSÃO: O tratamento com a LBI melhora a dor e função a curto prazo de pacientes portadores de OA do joelho.

OBJECTIVE: This study was designed to evaluate the short-term efficacy of low-level laser therapy (LLLT) for improving pain and function in patients with knee osteoarthritis. METHODS: Forty-seven patients with knee osteoarthritis (79 knees), of both genders, participated in this randomized controlled double-blind clinical trial. They were randomly allocated to two groups: laser group with 25 patients (41 knees) and placebo group with 22 patients (38 knees). LLLT was performed three times a week, totaling nine sessions, using a AsGa 904 nm laser with mean power of 60 mW and beam area of 0.5 cm². Nine points were irradiated on the knee, with energy of 3.0 J/point. The placebo group was treated with the same laser device, but with a sealed probe. Evaluations using Lequesne, visual numerical scale (VNS), Timed Up and Go (TUG), goniometry and dynamometry were conducted before the treatment started and after the nine sessions of LLLT. RESULTS: A significant improvement in pain and function was found in all the assessments applied to the laser group. On comparing the laser group with the placebo group, significant differences were found in the VNS-resting and Lequesne evaluations. CONCLUSION: Treatment with LLLT improves pain and function over the short term in patients with knee osteoarthritis.

Functional status change in older adults undergoing coronary artery bypass surgery.

CONTEXT AND OBJECTIVE: Increased life expectancy has resulted in growing numbers of elderly patients undergoing heart surgery. This study aimed to identify changes in functional status among older adults undergoing coronary artery bypass grafting. DESIGN AND SETTING: Prospective observational cohort study conducted at a level IV private hospital in Brazil. METHODS: Patients were assessed using the Katz and Lawton scales and the Functional Independence Measure before admission, at hospital discharge and one month after discharge. Repeated-measurement analysis of variance was used. RESULTS: Two patients died during hospitalization. Among the 31 patients included, the Functional Independence Measure ranged from 121.7 ± 7.4 (pre-admission) to 91.1 ± 20.5 (discharge) and 109.0 ± 21.7 (one month after discharge); the Katz scale from 5.92 ± 0.32 to 4.18 ± 1.04 and 5.13 ± 1.30; and the Lawton scale from 24.3 ± 4.6 to 12.8 ± 2.0 and 16.5 ± 4.6 (P = 0.0001). When subgroups with (18) and without (13) complications were compared, the Functional Independence Measure (P = 0.085) showed a trend, although not significantly, toward recovery one month after discharge. Delirium and blood transfusion were the intercurrent events found. There was a correlation between the scales and age (P = 0.008), APACHE II (P = 0.051), EuroSCORE (P = 0.064), intensive care unit stay (P = 0.024) and overall hospital length of stay (P = 0.040). CONCLUSION: The Functional Independence Measure proved to be a promising tool for monitoring the functional status of elderly patients undergoing coronary artery bypass grafting, especially in the subgroup with complications.

Functional status change in older adults undergoing coronary artery bypass surgery / Modificação da capacidade funcional em idosos submetidos a cirurgia de revascularização miocárdica

CONTEXT AND OBJECTIVE: Increased life expectancy has resulted in growing numbers of elderly patients undergoing heart surgery. This study aimed to identify changes in functional status among older adults undergoing coronary artery bypass grafting. DESIGN AND SETTING: Prospective observational cohort study conducted at a level IV private hospital in Brazil. METHODS: Patients were assessed using the Katz and Lawton scales and the Functional Independence Measure before admission, at hospital discharge and one month after discharge. Repeated-measurement analysis of variance was used. RESULTS: Two patients died during hospitalization. Among the 31 patients included, the Functional Independence Measure ranged from 121.7 ± 7.4 (pre-admission) to 91.1 ± 20.5 (discharge) and 109.0 ± 21.7 (one month after discharge); the Katz scale from 5.92 ± 0.32 to 4.18 ± 1.04 and 5.13 ± 1.30; and the Lawton scale from 24.3 ± 4.6 to 12.8 ± 2.0 and 16.5 ± 4.6 (P = 0.0001). When subgroups with (18) and without (13) complications were compared, the Functional Independence Measure (P = 0.085) showed a trend, although not significantly, toward recovery one month after discharge. Delirium and blood transfusion were the intercurrent events found. There was a correlation between the scales and age (P = 0.008), APACHE II (P = 0.051), EuroSCORE (P = 0.064), intensive care unit stay (P = 0.024) and overall hospital length of stay (P = 0.040). CONCLUSION: The Functional Independence Measure proved to be a promising tool for monitoring the functional status of elderly patients undergoing coronary artery bypass grafting, especially in the subgroup with complications.

CONTEXTO E OBJETIVO: Com o aumento da expectativa de vida tem-se visto incremento nas cirurgias cardíacas em idosos. Este estudo teve como objetivo identificar variações da capacidade funcional em idosos submetidos a cirurgia de revascularização miocárdica. TIPO DE ESTUDO E LOCAL: Estudo de coorte, prospectivo e observacional realizado em um hospital privado nível IV, Brasil. MÉTODOS: Trinta e três pacientes foram avaliados pelas escalas de Katz e Lawton pela Medida de Independência Funcional na pré-internação, alta hospitalar e um mês pós-alta. Análise de variância para medidas repetidas foi utilizada. RESULTADOS: Dois óbitos ocorreram durante a hospitalização. Entre os 31 pacientes incluídos, a Medida de Independência Funcional variou de 121,7 ± 7,4 (pré-internação) a 91,1 ± 20,5 (alta) e 109,0 ± 21,7 (um mês pós-alta); Katz de 5,92 ± 0,32 a 4,18 ± 1,04 e 5,13 ± 1,30; e Lawton de 24,3 ± 4,6 a 12,8 ± 2,0 e 16,5 ± 4,6 (P = 0,0001). Quando comparados subgrupos com (18) e sem complicações (13), a Medida de Independência Funcional (P = 0,085) apresentou tendência, embora não significativa, de recuperação um mês pós-alta. Delirium e transfusão sanguínea foram intercorrências encontradas. Houve correlação entre as escalas com idade (P = 0,008), APACHE II (P = 0,051), EuroSCORE (P = 0,064), e tempos de permanência na unidade de terapia intensiva (P = 0,024) e no hospital (P = 0,040). CONCLUSÃO: A medida de independência funcional mostrou-se promissora para o acompanhamento da funcionalidade de idosos após a cirurgia de revascularização miocárdica, destacando-se subgrupo com complicações.

SHORT-TERM EFFICACY OF LOW-LEVEL LASER THERAPY IN PATIENTS WITH KNEE OSTEOARTHRITIS: A RANDOMIZED PLACEBO-CONTROLLED, DOUBLE-BLIND CLINICAL TRIAL.

OBJECTIVE: This study was designed to evaluate the short-term efficacy of low-level laser therapy (LLLT) for improving pain and function in patients with knee osteoarthritis. METHODS: Forty-seven patients with knee osteoarthritis (79 knees), of both genders, participated in this randomized controlled double-blind clinical trial. They were randomly allocated to two groups: laser group with 25 patients (41 knees) and placebo group with 22 patients (38 knees). LLLT was performed three times a week, totaling nine sessions, using a AsGa 904 nm laser with mean power of 60 mW and beam area of 0.5 cm(2). Nine points were irradiated on the knee, with energy of 3.0 J/point. The placebo group was treated with the same laser device, but with a sealed probe. Evaluations using Lequesne, visual numerical scale (VNS), Timed Up and Go (TUG), goniometry and dynamometry were conducted before the treatment started and after the nine sessions of LLLT. RESULTS: A significant improvement in pain and function was found in all the assessments applied to the laser group. On comparing the laser group with the placebo group, significant differences were found in the VNS-resting and Lequesne evaluations. CONCLUSION: Treatment with LLLT improves pain and function over the short term in patients with knee osteoarthritis.

Successful surgical management of an extrahepatic biliary cystadenocarcinoma.

Extrahepatic bile duct cancer is an uncommon disease, and few cases are curable by surgery. We report a case of extrahepatic biliary cystadenocarcinoma (BCAC) associated with atrophy of the left hepatic lobe. A 54-year old male was admitted with painless obstructive jaundice and a hepatic palpable mass noticed one month before presentation. Liver functions tests were consistent with cholestatic damage and serum carbohydrate antigen 19.9 (CA 19-9) was increased before treatment. Magnetic resonance imaging (MRI) disclosed dilatation of the left hepatic bile duct with irregular wall thickening close to the hepatic confluence, and atrophy of left hepatic lobe. The patient was submitted to en bloc extended left hepatectomy with resection of caudate lobe, hilar lymphadenectomy, and suprapancreatic biliary tree resection. All surgical margins were grossly negative, and postoperative course was uneventful, except for a minor bile leak. The patient was discharged on the 15th postoperative day; he is alive without tumor recurrence one year after primary therapy. Although technically challenging, extended en bloc resection is feasible in adults with extrahepatic BCAC and can improve survival with acceptable and manageable morbidity.

Centro de convivência: uma proposta de cuidado humanizado para os idosos do Centro de Saúde IAPI

O trabalho apresenta uma proposta de implantação de um Centro de Convivência para idosos no Centro de Saúde IAPI. Propõe a adaptação da área física destinada ao atendimento em um Centro de Convivência. Busca a criação de um trabalho de atenção aos idosos utilizando voluntariado .

Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário / Prevalence of ventilator-associated pneumonia in a university hospital and prognosis for the patients affected

OBJETIVO: Determinar prevalência de pneumonia associada à ventilação mecânica em unidade de terapia intensiva, fatores associados e evolução. MÉTODOS: Foram avaliados 278 pacientes sob ventilação mecânica por mais de 24 horas prospectivamente em hospital universitário. RESULTADOS: Desenvolveram a doença 38,1 por cento dos pacientes, 35,7 casos/1.000 dias de ventilação mecânica: 45,3 por cento por bacilos gram negativos, Pseudomonas aeruginosa (22 por cento) o mais comum e 43,4 por cento por germes multi-resistentes. O grupo com pneumonia associada à ventilação mecânica teve maiores tempos de ventilação mecânica, desmame, permanência no hospital e na unidade de terapia intensiva (p < 0,001); atelectasia, síndrome do desconforto respiratório agudo, pneumotórax, sinusite, traqueobronquite e infecção multirresistente foram mais comuns (p < 0,05). Letalidades na unidade de terapia intensiva e no hospital foram semelhantes. Fatores associados à doença (razão de chances; intervalo de confiança 95 por cento): sinusite aguda (38,8; 3,4 - 441), ventilação mecânica >10 dias (7,7; 4,1 - 14,2), imunodepressão (4,3; 1,3 - 14,3), síndrome do desconforto respiratório agudo (3,5; 1,4 - 9,0), atelectasia (3,0; 1,2 - 7,3), parada cardiorrespiratória (0,18; 0,05 - 0,66) e hemorragia digestiva alta (0,07; 0,009 - 0,62]. Fatores associados ao óbito hospitalar: insuficiência renal crônica (26,1; 1,9 - 350,7), admissão prévia na unidade de terapia intensiva (15,6; 1,6 - 152,0), simplified acute physiologic score II > 50 pontos (11,9; 3,4 - 42,0) e idade > 55 anos (4,4; 1,6 - 12,3). CONCLUSÃO: A pneumonia associada à ventilação mecânica aumentou tempos de ventilação mecânica, permanência na unidade de terapia intensiva e no hospital, número de complicações, mas não a letalidade.

OBJECTIVE: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution. METHODS: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital. RESULTS: Ventilator-associated pneumonia developed in 38.1 percent of the patients, translating to 35.7 cases/1000 ventilator-days: 45.3 percent were caused by gram-negative agents (Pseudomonas aeruginosa accounting for 22 percent); and multidrug resistant organisms were identified in 43.4 percent. In the ventilator-associated pneumonia group, time on mechanical ventilation, time to mechanical ventilation weaning, hospital stays and intensive care unit stays were all longer (p < 0.001). In addition, atelectasis, acute respiratory distress syndrome, pneumothorax, sinusitis, tracheobronchitis and infection with multidrug resistant organisms were more common in the ventilator-associated pneumonia group (p < 0.05). Mortality rates in the intensive care unit were comparable to those observed in the hospital infirmary. Associations between ventilator-associated pneumonia and various factors are expressed as odds ratios and 95 percent confidence intervals: acute sinusitis (38.8; 3.4-441); > 10 days on mechanical ventilation (7.7; 4.1-14.2); immunosuppression (4.3; 1.3-14.3); acute respiratory distress syndrome (3.5; 1.4-9.0); atelectasis (3.0; 1.2-7.3); cardiac arrest (0.18; 0.05-0.66); and upper gastrointestinal tract bleeding (0.07; 0.009-0.62). The variables found to be associated with in-hospital death were as follows: chronic renal failure (26.1; 1.9-350.7); previous intensive care unit admission (15.6; 1.6-152.0); simplified acute physiologic score II > 50 (11.9; 3.4-42.0); and age > 55 years (4.4; 1.6-12.3). CONCLUSION: Ventilator-associated pneumonia increased the time on mechanical ventilation and the number of complications, as well as the length...

[Effects of cimetidine on chronotropic response to cardiopulmonary exercise testing]. / Resposta cronotrópica ao teste cardiopulmonar após o uso de cimetidina.

OBJECTIVE: To test the hypothesis that the administration of cimetidine will modify the chronotropic response to exercise testing through a random clinical trial. METHODS: The study selected 24 eligible healthy subjects, ages between 20 and 68 years, not athletes, who agreed to undergo cardiopulmonary exercise testing after the administration of placebo and 400 mg of cimetidine twice a day for one week. The tests were performed on a treadmill using a ramp protocol and direct analysis of the expired gases. Peak, resting and anaerobic threshold heart rate were recorded. RESULTS: The twenty subjects studied were equally distributed across sex with mean (+/- SD) age 43 +/- 11 years. Tests on placebo and on cimetidine presented similar duration (578 +/- 90 sec vs 603 +/- 131 sec) and similar peak oxygen uptake (35 +/- 8 ml/kg.min vs 35 +/- 8 ml/kg.min). Cimetidine administration had no significant effect on resting heart rate (75 +/- 10 bpm vs 74 +/- 8 bpm), heart rate at peak exercise (176 +/- 12 bpm vs 176 +/- 11 bpm), and on the difference between the peak and the resting heart rates--delta HR (101 +/- 14 bpm vs 101 +/- 13 bpm). CONCLUSION: The administration of cimetidine for 7 days has no significant effect on the chronotropic response to exercise testing.

Resposta cronotrópica ao teste cardiopulmonar após o uso de cimetidina / Effects of cimetidine on chronotropic response to cardiopulmonary exercise testing

OBJETIVO: Testar a hipótese, por meio de ensaio clínico randomizado, de que a administração de cimetidina altera a resposta cronotrópica ao exercício. MÉTODOS: Foram selecionados 24 indivíduos saudáveis, com idade entre 20 e 68 anos, não-atletas, os quais concordaram em ser submetidos a testes cardiopulmonares, após uso de placebo e de cimetidina, 400 mg, duas vezes ao dia, durante uma semana. Os testes foram realizados em esteira rolante, com protocolo de rampa com análises diretas dos gases expirados. Foi avaliada freqüência cardíaca máxima atingida, além da freqüência cardíaca de repouso e do limiar anaeróbico. RESULTADOS: Os indivíduos estudados foram igualmente distribuídos por sexo, com idade média (± desvio padrão) de 43 ±11 anos. Os exames com placebo e com cimetidina tiveram igual duração (578±90 seg vs 603±131 seg) e igual VO2 pico (35±8 ml/kg.min vs 35±8 ml/kg.min). A administração de cimetidina não apresentou efeito significativo na freqüência cardíaca de repouso (75±10 vs 74±8 bpm), no pico do esforço (176±12 vs 176±11 bpm) e, da mesma forma, também não houve diferença entre as variações das freqüências cardíacas (pico - repouso), nos dois estudos (101±14 vs 101±13 bpm). CONCLUSÃO: A administração de cimetidina por sete dias não altera a resposta cronotrópica ao exercício.