RESUMO
OBJECTIVE: The objective of the study is to determine the usefulness of the SOFA (Sequential Organ Failure Assessment), quick SOFA (qSOFA), LODS (Logistic Organ Dysfunction System) and EWS (Early Warning Score) scores to predict in-hospital mortality among septic patients attended in the emergency department; to evaluate what factors are associated with mortality; and develop a predictive model of in-hospital mortality. METHODS: Retrospective study including patients over 14 years of age included in the sepsis code of an Emergency Department of a University Hospital between November 2013 and September 2015. Demographic variables, hemodynamic and analytical variables, and in-hospital mortality were collected to obtain qSOFA, SOFA, LODS, EWS scores. Receiver operating characteristic curves were constructed for each score. Logistic regression was used to evaluate the probability of in-hospital mortality. RESULTS: A total of 349 patients were analyzed, median age 72.7 (range 86), males: 54.4%. The in-hospital mortality was 21.8%. AUC obtained: LODS: 0.73 (IC 95% 0.67-0.80; p<0.001), EWS: 0.73 (IC 95% 0.65-0.81; p<0.001), SOFA: 0.72 (IC 95% 0.65- 0.78; p<0.001), qSOFA: 0.67 (IC 95% 0.58-0.76; p<0.001). After the multivariate analysis, these were the independent factors associated with in-hospital mortality: Oxygen saturation ≤92%, Glasgow coma score <14, lactate ≥2mmol/L (p<0.05). Two prognostic models were generated: MPRO1: age, oxygen saturation ≤92% and Glasgow coma score <14, AUC: 0.78 (IC 95% 0.72-0.84; p<0.001) and MPRO2 formed by the previous ones and lactate ≥2mmol/L, AUC: 0.82 (IC 95% 0.76-0.87; p<0.001). CONCLUSIONS: SOFA score and the new developed scores could be useful in asses the risk of in-hospital mortality in patients included in the sepsis code.
Assuntos
Serviço Hospitalar de Emergência , Sepse/diagnóstico , Sepse/terapia , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência , Feminino , Hemodinâmica , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Sepse/mortalidade , Adulto JovemRESUMO
Experiments were conducted to evaluate the effects of chronic buspirone (1 mg/kg/day) on the influenza A (PR-8/34) virus specific immune injury in CD-1 mice exposed to a chronic auditory stressor. Treatment with buspirone resulted in a decrease of the stress-induced increase of virus titers and pulmonary vascular permeability as well as in a reduction of the mortality of mice.
Assuntos
Buspirona/farmacologia , Vírus da Influenza A/crescimento & desenvolvimento , Infecções por Orthomyxoviridae/imunologia , Estresse Fisiológico/complicações , Animais , Permeabilidade Capilar , Imunidade Inata/efeitos dos fármacos , Pulmão/virologia , Masculino , Camundongos , Infecções por Orthomyxoviridae/complicações , Infecções por Orthomyxoviridae/virologia , Alvéolos Pulmonares/irrigação sanguínea , Distribuição AleatóriaRESUMO
In this paper we report a Gorlin's syndrome in a patient, who was first diagnosed as a case of a large odontogenic keratocyst. Posterior analysis demonstrate the presence of other keratocyst in the maxilla and in the mandible, as well as lumbar scoliosis, lack and malformation of ribs, calcification of the brain sickle and folicles of 8 mm of diameter in the right ovary. The possible presence of nevoid basal cell carcinomas will be also considered.