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1.
Rev. Esc. Enferm. USP ; 53: e03505, Jan.-Dez. 2019. tab, graf
Article in English, Portuguese | LILACS, BDENF - Nursing | ID: biblio-1020375

ABSTRACT

RESUMO Objetivo Avaliar a evolução clínica e sobrevida de pacientes neurocríticos em Unidades Hospitalares. Método Coorte com pacientes acompanhados no período de setembro de 2012 a junho de 2016, internados em hospitais públicos e privados. Os dados foram analisados inicialmente a partir da estatística descritiva e inferencial. Como forma de análise da sobrevida, foi aplicado o indicador de Kaplan-Meier. O modelo de regressão para riscos proporcionais de Cox foi empregado para a análise dos fatores prognósticos, calculando-se a razão de risco. Resultados Participaram do estudo 1.289 pacientes. Os que possuíam Escala de Coma de Glasgow com maior valor apresentaram maior sobrevida, e o incremento de um ponto no escore dessa Escala correspondeu a uma melhora de 42% em sua sobrevida. Na análise de sobrevida, o sexo e o uso de drogas vasoativas mostraram diferença significativa. Conclusão Pacientes do sexo feminino, que possuem melhor escore da Escala de Coma de Glasgow e em uso de drogas vasoativas apresentaram maior sobrevida.


RESUMEN Objetivo Evolución clínica y supervivencia de pacientes neurocríticos en Unidades Hospitalarias. Método Cohorte con pacientes seguidos en el período de septiembre de 2012 a junio de 2016, en estancia en hospitales públicos y privados. Los datos fueron analizados inicialmente mediante la estadística descriptiva e inferencial. Como modo de análisis de la supervivencia, se aplicó el indicador de Kaplan-Meier. El modelo de regresión para riesgos proporcionales de Cox fue empleado para el análisis de los factores pronósticos, calculándose la razón de riesgo. Resultados Participaron en el estudio 1.289 pacientes. Los que tenían Escala de Coma de Glasgow con mayor valor presentaron mayor supervivencia, y el incremento de un punto en el score de dicha Escala correspondió a un mejora del 42% en su supervivencia. En el análisis de supervivencia, el sexo y el uso de drogas vasoactivas mostraron diferencia significativa. Conclusión Pacientes del sexo femenino que tienen mejor score de la Escala de Coma de Glasgow y en uso de drogas vasoactivas presentaron mayor supervivencia.


ABSTRACT Objective To evaluate the clinical evolution and survival of neurocritical patients in Hospital Units. Method Cohort with hospitalized patients in follow-up treatment in public and private hospitals between September 2012 and June 2016. Data were initially analyzed from descriptive and inferential statistics. The Kaplan-Meier indicator was applied as a form of survival analysis. The Cox proportional hazards regression model was used to analyze the prognostic factors by calculating the hazard ratio. Results Participation of 1,289 patients in the study. Patients with a higher score on the Glasgow Coma Scale presented greater survival, and the one-point increase in the scale score corresponded to 42% improvement in their survival. In the analysis of survival, sex and the use of vasoactive drugs showed a significant difference. Conclusion Female patients with a better score on the Glasgow Coma Scale and using vasoactive drugs had higher survival rates.


Subject(s)
Humans , Glasgow Coma Scale , Clinical Evolution , Critical Care , Cohort Studies , Critical Care Nursing
2.
Rev. Esc. Enferm. USP ; 53: e03486, Jan.-Dez. 2019. tab
Article in English, Portuguese | LILACS, BDENF - Nursing | ID: biblio-1020393

ABSTRACT

RESUMO Objetivo Avaliar o impacto das Infecções Relacionadas à Assistência à Saúde no custo da hospitalização de crianças. Método Estudo de coorte, prospectivo, quantitativo, envolvendo crianças admitidas nas Unidades de Internação e de Terapia Intensiva Pediátrica de um hospital universitário público. Os dados foram analisados por meio do software SPSS por distribuição de frequências, medidas de tendência central e dispersão. Para todas as análises foi considerado o nível de significância estatística de p<0,05. Resultados A amostra foi composta de 173 crianças, destas, 18,5% desenvolveram infecção relacionada à assistência à saúde, que aumentou em 4,2 vezes (p<0,001) o custo da hospitalização. Maior impacto de custo foi observado entre pacientes com dois ou mais sítios infecciosos (R$ 81.037,57, p=0,010) e sepse (R$ 46.315,63 p<0,001). Crianças colonizadas por microrganismos multirresistentes, com prevalência de E. coli e A. baumannii ESBL, geraram custos maiores, R$ 35.206,15 e R$ 30.692,52, respectivamente. Conclusão As infecções relacionadas à assistência à saúde aumentaram significativamente os custos da hospitalização de crianças, em especial entre aquelas com mais de dois sítios infecciosos, que desenvolveram sepse e colonizadas por microrganismos multirresistentes.


RESUMEN Objetivo Evaluar el impacto de las Infecciones Relacionadas con la Asistencia Sanitaria en el costo de la hospitalización de niños. Método Estudio de cohorte, prospectivo, cuantitativo, involucrando a niños ingresados en las Unidades de Hospitalización y de Cuidados Intensivos Pediátricos de un hospital universitario público. Los datos fueron analizados mediante el software SPSS por distribución de frecuencias, medidas de tendencia central y dispersión. Para todos los análisis, se consideró el nivel de significación estadística de p<0,05. Resultado La muestra estuvo compuesta de 173 niños, de estos el 18,5% desarrollaron infección relacionada con la asistencia sanitaria, que aumentó 4,2 veces (p<0,001) el costo de la estancia hospitalaria. Mayor impacto de costo fue observado entre pacientes con dos o más sitios infecciosos (R$ 81.037,57, p=0,010) y sepsis (R$ 46.315,63 p<0,001). Niños colonizados por microorganismos multirresistentes, con prevalencia de E. coli y A. baumannii ESBL, generaron costos mayores, R$ 35.206,15 y R$ 30.692,52, respectivamente. Conclusión Las infecciones relacionadas con la asistencia sanitaria aumentaron significativamente los costos de la hospitalización de niños, en especial entre los con más de dos sitios infecciosos, que desarrollaron sepsis y colonizados por microorganismos multirresistentes.


ABSTRACT Objective To evaluate the impact of Healthcare-Associated Infections on the hospitalization cost of children. Method A prospective, quantitative cohort study involving children admitted to the Inpatient and Pediatric Intensive Care Units of a public university hospital. The data were analyzed through SPSS software by frequency distribution, central tendency measures and dispersion. The level of statistical significance was set at p<0.05 for all analyzes. Results The sample consisted of 173 children, of whom 18.5% developed Healthcare-Associated Infections, which increased the hospitalization costs 4.2 times (p<0.001). A greater cost impact was observed among patients with two or more infectious sites (R$81,037.57; p=0.010) and sepsis (R$46,315.63; p<0.001). Children colonized by multiresistant microorganisms with a prevalence of E. coli and A. baumannii ESBL also generated higher costs of R$35,206.15 and R$30,692.52, respectively. Conclusion Healthcare-Associated Infections significantly increased the hospitalization costs for children, especially among those with more than two infectious sites, who developed sepsis or were colonized by multiresistant microorganisms.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Child, Hospitalized , Cross Infection , Health Care Costs , Drug Resistance, Microbial , Intensive Care Units, Pediatric , Cohort Studies , Hospitals, University
3.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3 Supl): 287-290, jul.-set. 2019.
Article in Portuguese | LILACS | ID: biblio-1023063

ABSTRACT

Existem poucos sistemas de avaliação de mortalidade após transplante cardíaco (TC) que se baseiem em fatores relacionados com o doador e que sejam capazes de predizer o prognóstico. Identificar características dos doadores que têm impacto na sobrevida depois do TC pode contribuir para melhorar os resultados e a alocação de órgãos. Aplicamos um sistema de avaliação americano para predizer a mortalidade pós-TC em uma coorte brasileira. Objetivo: Avaliar um escore americano como preditor de mortalidade depois de TC em uma coorte brasileira. Métodos: Análise de uma base de dados de um centro de TC brasileiro de 2013 a 2015. Foram avaliadas quatro características dos doadores: tempo de isquemia, idade do doador, discordância racial doador/receptor e a função renal do doador. A sobrevida foi estimada pelo teste de log-rank em faixas de pontuação pré-determinadas. Resultados: Foram 110 doadores, 89% homens e 62% brancos. A principal causa de morte foi trauma (66,6%). Os doadores tinham em média 29,8 anos, 18,6 de relação Nitrogênio da ureia sanguínea / Creatinina, 175 minutos de tempo de isquemia e 42% de discordância racial com o receptor. Não houve diferença de sobrevida entre as faixas de pontuação. Conclusão: Apesar de preditor de mortalidade após transplante cardíaco em uma população americana, esse escore não foi útil para uma coorte de transplante brasileira. As diferenças, inclusive a alta taxa de miscigenação pode ser uma explicação para esses achados


here are few systems to assess mortality after heart transplantation (CT) that are based on donor-related factors and can predict prognosis. Identifying donor characteristics that impact post-CT survival can contribute to improved outcomes and organ allocation. We applied a US evaluation system to predict mortality after CT in a Brazilian cohort. Objective: To evaluate an American score as a predictor of mortality following CT in a Brazilian cohort. Method: Database analysis of a Brazilian CT center from 2013 to 2015. Four donor characteristics were evaluated: ischemia time, donor age, donor-recipient race mismatch, and donor renal function. Survival was estimated by the log-rank test in predetermined score ranges. Results: There were 110 donors, 89% male and 62% white. The main cause of death was trauma (66.6%). Donors had a mean age of 29.8 years, a mean blood urea nitrogen / creatinine ratio of 18.6, a mean ischemia time of 175 minutes, and race mismatch with the recipient of 42%. There was no difference in survival between the score ranges. Conclusion: Although it was a predictor of mortality after cardiac transplantation in an American population, this score was not useful for a Brazilian transplant cohort. Differences, including the high rate of miscegenation, may explain these findings


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Tissue Donors , Transplantation/mortality , Heart Transplantation/mortality , Prognosis , Cardiovascular Diseases , Survival Analysis , Prevalence , Predictive Value of Tests , Cohort Studies , Treatment Outcome , Heart Failure/therapy
4.
Prensa méd. argent ; 105(6): 361-369, Jul 2019. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1023787

ABSTRACT

Influenza is a respiratory disease ocasionated by influenza virus A and B. Is a disease with high morbi-mortality world-wide. Influenza produces an acute febrile respiratory illness with cough, headache and myalgias for 3-4 days, with simptoms that may persist for as long as 2 weeks. There are three types of influenza virsuses: A, B and C, of whom the type a has a higher ability to originate pandemias and is subclassified according to their surface antigens: hemaglutinine (H) and neuraminidase (N). Of the capacity of mutation that has the influenza virus and the consequent expression of different proteins, can modify its virulence. The transmission route is through direct contact with secretetory repirations. The transmission route is through direct contact with secretetory repirations. The incubation period is scant, between 12-72 hs. The aim of this study was to compare the clinical characteristics demographicals and evolutive of pediatric patients hospitalized because by Influenze A: subtypes H1N1 (pdm2009) and H3N2. An observative study was performed, retrospective, using data of hospitalizations of children during the years 2016 and 2017 with influenza A confirmed by laboratory. The study also, aimed to evaluate if the viral subtype constitutes a factor of risk, independent for complicated hospitalization (admission to intensive care and/or development of complications) in hospitalized children. The results obtained in the study are detailed in the paper. In conclusion, both viral subtypes affected mainly to children with risk factors. The viral subtype H1N1 was related with higher severety in hospitalized children. is of most importance to perform preventive works, specially in vulnerable groups, offering a good cover of immunizations. The clinical parameters arae commented (AU)


Subject(s)
Humans , Child , Comorbidity/trends , Epidemiologic Factors , Statistical Analysis , Retrospective Studies , Cohort Studies , Sample Size , Patient Selection , Influenza A Virus, H1N1 Subtype/pathogenicity , Influenza A Virus, H3N2 Subtype/pathogenicity , Influenza in Birds/complications , Risk Factors
5.
Med. infant ; 26(2): 85-91, Junio 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1009024

ABSTRACT

Objetivos: Analizar las características demográficas, clínicas, microbiológicas, evolución y factores de riesgo de morbimortalidad asociados a la endocarditis de válvula nativa (EIN) en pacientes (p) pediátricos. Población y métodos: Se evaluaron 176 p con EIN, divididos en grupo I: <3meses (27p) y grupo II: >3meses (149p). Resultados: Grupo I: el 66% tenía corazón sano. El microorganismo más frecuente fue Staphylococcus aureus (44,4%). Afectación derecha (77,8%-p<0,0001). Evento principal: infección no controlada (INC) (52%, p=0,0009) y asociada a Candida (p<0,00001). Se indicó tratamiento quirúrgico a 10 p (37%). Mortalidad 29,6%(8p). Grupo II: el 57% presentaba cardiopatía previa. Microorganismos prevalentes: S.aureus (49,1%) y estreptococos del grupo viridans (22,5%). Hubo compromiso predominantemente izquierdo (p=0,001). Eventos: embolias sistémicas (36,2%-p=0,01), perforación valvular (51%-p=0,0005), insuficiencia cardíaca (26%-p=0,03) e INC (21,5%). La embolia sistémica se asoció a S.aureus (p=0,01). El 36,2% requirió cirugía. Mortalidad 6,7% (10p). En el análisis univariado la mortalidad se asoció a edad <3meses (p=0,0003), INC (p=0,002) y S.aureus (p=0,03). En el multivariado la mortalidad se relacionó a edad < 3meses (OR:7,50 ­IC95%:1,77­31,69) y a INC (OR:4,2-IC95%:1,16­15,29). Conclusiones: La EN se presentó en pacientes con corazón sano en el 50% de los casos. El microorganismo más frecuente fue S.aureus. En los <3 meses la infección no controlada fue la complicación más frecuente asociada a Candida, con afectación predominante de cavidades derechas. Los >3meses tuvieron mayor prevalencia de perforación valvular izquierda asociada a embolias sistémicas e insuficiencia cardíaca. El 35% de los p requirió cirugía. Los predictores de mortalidad fueron la edad <3meses y la INC.


Objectives: To analyze demographic, clinical, and microbiological, outcome, and morbidity and mortality risk factors associated with native valve endocarditis (NVE) in pediatric patients (p). Population and methods: 176 p with NVE were evaluated and divided into group I: <3 months (27p) and group II: >3 months (149p). Results: Group I: 66% had a healthy heart. The most common microorganism was Staphylococcus aureus (44.4%). Right-sided involvement (77.8%-p<0.0001). Main event: Uncontrolled infection (UCI) (52%, p-0.0009) and association with Candida (p<0.00001). Surgical treatment was indicated in 10 p (37%). Mortality was 29.6% (8p). Group II: 57% had previous heart disease. Prevalent microorganisms: S. aureus (49.1%) and viridans group streptococci ( (22.5%). Left-sided involvement predominated (p-0.001). Events: systemic embolism (36.2%-p-0.01), valve perforation (51%-p-0.0005), heart failure (26%-p-0.03), and UCI (21.5%). Systemic embolism was associated with S. aureus infection (p-0.01). 36.2% required surgery. Mortality was 6.7% (10p). In univariate analysis, mortality was associated with age <3 months (p-0.0003), UCI (p-0.002), and S. aureus infection (p-0.03). In multivariate analysis, mortality was related to age <3 months (OR:7.50 ­ 95% CI:1.77­31.69) and UCI (OR:4.2 -95% CI:1.16­15.29). Conclusions: NVE was observed in patients with a healthy heart in 50% of cases. The most common microorganism found was S. aureus. In the <3 months group, uncontrolled infection was the most common complication associated with Candida, predominantly affecting the right side. The >3 months group had a higher prevalence of left-valve perforation associated with systemic embolism and heart failure. 35% of p required surgery. Predictors of mortality were age <3 months and UC (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Staphylococcus aureus/isolation & purification , Viridans Streptococci/isolation & purification , Endocarditis/complications , Endocarditis/diagnosis , Endocarditis/microbiology , Endocarditis/mortality , Heart Valve Diseases/microbiology , Retrospective Studies , Cohort Studies
6.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(1): 63-70, Jan.-Mar. 2019. tab
Article in English | LILACS | ID: biblio-1013124

ABSTRACT

Abstract Objectives: to identify the frequency and factors associated with the non-realization of puerperal consultations in women resident of a medium-sized municipality in Brazil. Methods: a prospective cohort study based on data collected in two time points, the first 48h and after the 42nd day post-childbirth. In order to analyze data, proportions were compared using the chi-square test, and the adjusted analysis was performed using Poisson regression, according to a predetermined hierarchical model. Significance level was set at 5%. Results: of the 572 women included in the study, 24.8% did not perform puerperal consul-tations. The factors associated with the non-realization of puerperal consultations were: lower income (1 st tercile PR= 2.01; CI95%= 1.21-3.33 - 2 nd tercile PR= 1.94; CI95%=1.17-3.20) and schooling (≤ 8 years PR= 2.00; CI95%= 1.24-3.24), comorbidities during preg-nancy (PR= 1.45; CI95%= 1.01-2.09), realization of antenatal care in the public service (PR= 1.74; CI95%= 1.18-2.58) and non-use of contraceptive methods (PR= 3.10; CI95%=1.86-5.16). Conclusions: puerperal revision does not seem to be valued in the antenatal care, mainly in the public health system. An important inequality was identified in the provision of this service, since women more prone to recurring pregnancy and with lower income and schooling were the ones that least returned to the puerperal consultation.


Resumo Objetivos: identificar a frequência da não realização das consultas de puerpério e fatores associados em mulheres residentes de um município de médio porte no Brasil. Métodos: estudo de coorte prospectiva através da coleta de dados em dois momentos, nas primeiras 48h e após o 42º dia pós-parto. Para a análise dos dados, utilizou-se o teste qui-quadrado para comparar proporções e, para a análise ajustada, Regressão de Poisson obedecendo ao modelo hierárquico pré-determinado. O nível de significância adotado foi de 5%. Resultados: das 572 mulheres incluídas no estudo, 24,8% não realizaram consulta de puerpério. Os fatores associados a não realização da consulta de puerpério foram: menor renda (1º tercil RP= 2,01 IC95%= 1,21-3,33 - 2º tercil RP= 1,94 IC95%= 1,17-3,20), escolaridade (≤ 8 anos RP= 2,00 IC95%= 1,24-3,24); mulheres que apresentaram alguma comorbidade durante a gestação (RP 1,45; IC95%= 1,01-2,09), realizaram o pré-natal em serviço público (RP= 1,74; IC95%= 1,18-2,58) e que não usaram método anticoncepcional (RP= 3,10; IC95%= 1,86-5,16). Conclusões: a revisão puerperal não parece estar sendo valorizada no pré-natal, principalmente no sistema público de saúde. Foi identificada uma importante iniquidade na prestação desse serviço, pois as mulheres de menor renda, escolaridade e mais expostas a uma gravidez recorrente foram as que menos retornaram à consulta puerperal.


Subject(s)
Humans , Female , Pregnancy , Referral and Consultation/statistics & numerical data , Cohort Studies , Postpartum Period , Health Status Disparities , Maternal-Child Health Services , Primary Health Care , Unified Health System , Brazil
8.
Int. arch. otorhinolaryngol. (Impr.) ; 23(1): 70-76, Jan.-Mar. 2019. tab
Article in English | LILACS | ID: biblio-1002173

ABSTRACT

Abstract Introduction Dichotic listening refers to the ability to hear different sounds presented to each ear simultaneously. Objective The aim of the present study was to assess dichotic listening in women throughout the menstrual cycle. Methods The volunteers who met the eligibility criteria participated in a dichotic listening assessment composed of three tests: 1) staggered spondaic word test; 2) dichotic digits test; and 3) consonant-vowel test. The female participants were tested during two different phases of the menstrual cycle: the follicular (days 11 to 13) and luteal (days 23 to 26) phases. The phases were confirmed by measuring serum levels of the hormone estradiol. Results A total of 20 volunteers aged 18 to 49 years participated in the study (9 females and 11 males). In test 1, only the right ear of females showed better performance during the follicular phase (high estrogen levels), compared with the luteal phase (low estrogen levels); in test 2, there were no significant differences for any of the groups; and in test 3, both males and females showed significantly better performance in their right ear compared with their left ear. Conclusion The better performance of females during the follicular phase of the cycle may indicate that estrogen levels might have an influence on dichotic listening in women. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Auditory Perception/physiology , Estrogens/blood , Menstrual Cycle/physiology , Cohort Studies , Longitudinal Studies , Hearing Tests
9.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(1): 173-184, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013132

ABSTRACT

Abstract Objectives: to analyze associations among violence against pregnant women, depressive symptoms during pregnancy and maternal depression symptoms. Methods: a sample of 1,139 mothers was conducted on a prenatal cohort study in the municipality of São Luís in Brazil. Psychological and physical violence against pregnant women were measured by the World Health Organization Violence Against Woman. Depressive symptoms during pregnancy were measured by the Escala de Depressão do Centro de Estudos Epidemiológicos (CES-D) (Depression Scale for Epidemiological Studies Center) and maternal depression symptoms were measured by the Edinburgh Postnatal Depression Scale (EPDS). The conceptual model of the structural equation modeling contained socioeconomic situation, social support, psychological and physical violence and depression during pregnancy as determinants of the maternal depression symptoms. Results: maternal depression symptoms were more frequently reported by pregnant women who suffered psychological violence (Standardized Coefficient, SC=0.256; p-value, p<0.001), physical violence (SC=0.221 p<0.001) and those who presented depressive symptoms during pregnancy SC=0.322, p<0.001). Depressive symptoms during pregnancy mediated the effects on physical and psychological violence on maternal depression. Conclusions: pregnant women who were submitted to psychological and physical violence and presented depressive symptoms during pregnancy frequently reported more of having maternal depression symptoms.


Resumo Objetivos: analisar associações entre violência contra gestantes, sintomas de depressão na gestação e sintomas de depressão materna. Métodos: estudo em uma coorte de pré-natal no município de São Luís (Brasil) com amostra de 1.139 mães. Violência psicológica e violência física contra gestantes foram medidas pelo instrumento World Health Organization Violence against woman. Sintomas de depressão na gestação foram medidos pela Escala de Depressão do Centro de Estudos Epidemiológicos (CES-D) e sintomas de depressão materna foram medidos pela Escala de Depressão materna de Edimburgo (EPDS). O modelo conceitual, por modelagem de equações estruturais, teve situação socioeconômica, suporte social, violência psicológica, física e depressão na gestação como determinantes de sintomas de depressão materna. Resultados: Sintomas de depressão materna foram relatados por gestantes que mais frequentemente sofreram violência psicológica (Coeficiente Padronizado, CP=0.256; p-valor, p<0.001), violência física (CP=0.221 p<0.001) e apresentavam sintomas de depressão na gestação (CP=0.322 p<0.001). Sintomas de depressão na gestação mediaram efeitos das violências física e psicológica na depressão materna. Conclusões: gestantes submetidas à violência psicológica e física e que apresentaram sintomas de depressão na gestação relataram com mais frequência sintomas de depressão materna.


Subject(s)
Humans , Female , Pregnancy , Prenatal Care , Pregnancy , Cohort Studies , Depression , Violence Against Women , Self-Help Groups , Social Class , Brazil , Domestic Violence
10.
Rev. Esc. Enferm. USP ; 53: e03452, 2019. tab, graf
Article in English | LILACS, BDENF - Nursing | ID: biblio-1003095

ABSTRACT

ABSTRACT Objective: To identify factors related to the occurrence of urinary tract infection associated with urinary catheter use. Method: A longitudinal, retrospective cohort study carried out by analyzing the electronic medical records of patients admitted to an intensive care unit of a high-complexity hospital from July 2016 to June 2017. Demographic and clinical data were analyzed by descriptive and analytical analysis. Results: The incidence density of urinary tract infection related to urinary catheter use was 4.8 per 1000 catheters/day, the majority (80.6%) with no indication for catheter use, and there was no prescription for insertion and/or maintenance in 86.7%. The mean time between catheter insertion and infection diagnosis was 11.3 ± 6.3 days (6 to 28 days). Statistically significant factors (p < 0.001) related to urinary infection linked to catheter use were hospitalization time in the unit (16.7 ± 9 days), catheter permanence time (12.7 ± 6.9 days), and the use of antimicrobials in the intensive care unit (8.6 ± 6.3 days). Conclusion: The association of indication absence and the record of the need for maintenance possibly potentiated the occurrence of urinary tract infection associated to catheter use.


RESUMEN Objetivo: Identificar factores relacionados con la ocurrencia de infección del tracto urinario asociado con el uso del catéter vesical. Método: Estudio longitudinal, de cohorte retrospectivo, realizado por análisis de la ficha electrónica de pacientes ingresados en unidad de cuidados intensivos de un hospital de alta complejidad, de julio de 2016 a junio de 2017. Se evaluaron los datos demográficos y clínicos, por análisis descriptivo y analítico. Resultados: La densidad de incidencia de la infección urinaria relacionada con el uso del catéter vesical fue de 4,8 por 1.000 catéter/día, siendo la mayoría (80,6%) sin indicación para uso del catéter y, en el 86,7%, no había prescripción para inserción y/o mantenimiento. El tiempo medio entre inserción del catéter vesical y diagnóstico de infección fue de 111,3±6,3 días (6 a 28 días). Los factores estadísticamente significativos (p<0,001) relacionados con la infección urinaria relacionada con el uso del catéter vesical fueron tiempo de estancia hospitalaria en la unidad (12,7±6,9 días) y uso de antimicrobianos en la unidad de cuidados intensivos (8,6±6,3 días). Conclusión: La asociación de la ausencia de la indicación y del registro de la necesidad de mantenimiento posiblemente potenció la ocurrencia de infección urinaria relacionada con el uso del catéter vesical.


RESUMO Objetivo: Identificar fatores relacionados à ocorrência de infecção do trato urinário associada ao uso do cateter vesical. Método: Estudo longitudinal, coorte retrospectivo, realizado pela análise do prontuário eletrônico de pacientes admitidos em unidade de terapia intensiva de um hospital de alta complexidade, de julho de 2016 a junho de 2017. Avaliaram-se dados demográficos e clínicos, por análise descritiva e analítica. Resultados: A densidade de incidência da infecção urinária relacionada ao uso do cateter vesical foi de 4,8 por 1.000 cateter/dia, sendo a maioria (80,6%) sem indicação para uso do cateter e, em 86,7%, não havia prescrição para inserção e/ou manutenção. O tempo médio entre inserção do cateter vesical e diagnóstico de infecção foi de 11,3±6,3 dias (6 a 28 dias). Os fatores estatisticamente significativos (p<0,001) relacionados à infecção urinária relacionada ao uso do cateter vesical foram tempo de internação na unidade (16,7±9 dias), tempo de permanência do cateter vesical (12,7±6,9 dias) e uso de antimicrobianos na unidade de terapia intensiva (8,6±6,3 dias). Conclusão: A associação da ausência da indicação e do registro da necessidade de manutenção possivelmente potencializou a ocorrência de infecção urinária relacionada ao uso do cateter vesical.


Subject(s)
Humans , Adult , Infection Control , Catheter-Related Infections , Urinary Catheters/adverse effects , Retrospective Studies , Cohort Studies , Electronic Health Records , Patient Safety
11.
Rev. Esc. Enferm. USP ; 53: e03480, 2019. tab
Article in Portuguese | LILACS, BDENF - Nursing | ID: biblio-1013174

ABSTRACT

RESUMO Objetivo analisar as características maternas e desfechos perinatais e do primeiro ano de vida segundo a cor da pele autorreferida pelas mães. Método estudo de coorte com 507 mães e seus bebês, desenvolvido em município do interior paulista. O seguimento ocorreu de junho de 2015 a fevereiro de 2017. Os dados foram coletados em cinco momentos: no primeiro mês e aos três, seis, nove e 12 meses de vida da criança. Foram incluídas no estudo variáveis sociodemográficas, relativas ao pré-natal e parto. Entre os desfechos perinatais foram analisados o peso ao nascer e a necessidade de internação em unidades neonatais e entre os desfechos do primeiro ano de vida, ocorrência de infecção respiratória e a vigência de aleitamento materno. Resultados mulheres pretas/pardas apresentam situação sociodemográfica desfavorável quando comparadas às brancas. O único desfecho associado à cor da pele foi a vigência de aleitamento materno, mais favorável entre as mulheres pretas/pardas. Conclusão apesar da situação sociodemográfica desfavorável, considerando os desfechos selecionados, mulheres pretas/pardas não tiveram piores resultados. A hipótese de que a qualidade do atendimento pode anular os efeitos negativos de suas condições sociodemográficas precisa ser testada em futuros estudos.


RESUMEN Objetivo Analizar las características maternas y los resultados perinatales y del primer año de vida según el color de la piel autorreferida por las madres. Método Estudio de cohorte con madres y sus bebés, desarrollado en un municipio del interior del Estado de São Paulo. El seguimiento ocurrió de junio de 2015 a febrero de 2017. Los datos fueron recogidos en cinco momentos: al primer mes y a los tres, seis, nueve y 12 meses de vida del niño. Fueron incluidas en el estudio variables sociodemográficas, relacionadas con el prenatal y el parto. Entre los resultados perinatales, fueron analizados el peso al nacer y la necesidad de hospitalización en unidades neonatales, y entre los resultados del primer año de vida, ocurrencia de infección respiratoria y la vigencia de la lactancia. Resultados Participaron en el estudio 507 madres. Mujeres negras/mestizas presentaron situación sociodemográfica desfavorable cuando comparadas con las blancas. El único resultado más favorable entre las mujeres negras/mestizas fue la vigencia de lactancia. Conclusión A pesar de la situación sociodemográfica desfavorable, considerando los resultados seleccionados, mujeres negras/mestizas no tuvieron peores resultados. El supuesto de que la calidad de la atención puede anular los efectos negativos de sus condiciones sociodemográficas necesita probarse en futuros estudios.


ABSTRACT Objective To analyze the maternal characteristics and perinatal and the first year outcomes of life according to the self-reported color of the mothers. Method Cohort study with mothers and their babies developed in a city in the interior of São Paulo. Follow-up occurred from June 2015 to February 2017. Data were collected at five moments: in the first month and at three, six, nine and 12 months of the child's life. Sociodemographic variables related to prenatal and delivery were included in the study. Among the perinatal outcomes, we analyzed the birth weight and the need for hospitalization in neonatal units; for the outcomes of the first year of life, the occurrence of respiratory infection and the breastfeeding duration were measured. Results A total of 507 mothers participated in the study. Black/brown women presented an unfavorable socio-demographic situation when compared to white women. The only more favorable outcome among black/brown women was the breastfeeding duration. Conclusion Despite the unfavorable socio-demographic situation considering the selected outcomes, black/brown women did not have worse results. The hypothesis that the quality of care may negate the negative effects of their sociodemographic conditions needs to be tested in future studies.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Infant , Breast Feeding , Perinatal Care , African Continental Ancestry Group , Cohort Studies , Maternal-Child Nursing
12.
Mem. Inst. Oswaldo Cruz ; 114: e190075, 2019. tab, graf
Article in English | LILACS | ID: biblio-1002690

ABSTRACT

BACKGROUND The elimination of malaria depends on the blocking of transmission and of an effective treatment. In Brazil, artemisinin therapy was introduced in 1991, and here we present a performance overview during implementation outset years. METHODS It is a retrospective cohort (1991 to 2002) of patients treated in a tertiary centre of Manaus, with positive microscopic diagnosis of Plasmodium falciparum malaria, under treatment with using injectable or rectal artemisinin derivatives, and followed over 35-days to evaluate parasite clearance, death and recurrence. FINDINGS This cohort outcome resulted 97.6% (1554/1593) of patients who completed the 35-day follow-up, 0.6% (10/1593) of death and 1.8% (29/1593) of follow-up loss. All patients that died and those that presented parasitaemia recurrence had pure P. falciparum infections and received monotherapy. Considering patients who completed 35-day treatment, 98.2% (1527/1554) presented asexual parasitaemia clearance until D4 and 1.8% (27/1554) between D5-D10. It is important to highlight that had no correlation between the five treatment schemes and the sexual parasite clearance. Finally, it is noteworthy that we were able to observe also gametocytes carriage during all follow-up (D0-D35). MAIN CONCLUSIONS Artemisinin derivatives remained effective in the treatment of falciparum malaria during first 12-years of use in north area of Brazil.


Subject(s)
Humans , Plasmodium falciparum , Artemisinins , Drug Resistance , Communicable Disease Control , Cohort Studies
13.
Rio de Janeiro; s.n; 2019. 113 f p. graf, tab, fig.
Thesis in Portuguese | LILACS | ID: biblio-997864

ABSTRACT

A artrite reumatoide é uma doença inflamatória crônica com prevalência mundial estimada entre 0,5 e 1%, caracterizada por dor, edema e rigidez matinal nas articulações. A doença não controlada leva à destruição articular progressiva, causando perda da qualidade de vida e da capacidade funcional. A manutenção da capacidade envolve estar apto a realizar atividades básicas do cotidiano, envolvendo higiene pessoal, carregar objetos, vestir-se, alimentar-se e locomover-se. Limitações ou impossibilidade de realizar estas atividades implica em alguma incapacidade funcional - geralmente mensurada, na artrite reumatoide, por um dos componentes do Questionário de Avaliação de Saúde. Esta dissertação teve como objetivo geral analisar a variação da capacidade funcional medida pelo Questionário de Avaliação de Saúde ­ Índice de Incapacidade em pacientes com artrite reumatoide acompanhados ambulatorialmente por um ano e propor um modelo preditivo, em função de fatores sociodemográficos e clínicos. Os objetivos específicos foram: (i) avaliar quais variáveis, previamente reportadas na literatura, têm impacto sobre a capacidade funcional dos pacientes com artrite reumatoide de uma coorte nacional; (ii) construir um modelo preditivo próprio à realidade brasileira utilizando variáveis de fácil obtenção; e (iii) avaliar se há modificação de efeito pela interação entre atividade de doença e o tempo no estudo. Avaliamos 1111 pacientes com artrite reumatoide atendidos em 11 centros de referência para tratamento de doenças reumáticas vinculados ao Sistema Único de Saúde, com coleta de dados prospectiva. Utilizamos modelos lineares de efeitos mistos para avaliar a variação da capacidade funcional, mensurada pelo Questionário de Avaliação de Saúde ­ Índice de Incapacidade, nos dados coletados em três momentos ao longo de um ano. Esta análise revelou que, na população avaliada, sexo, status socioeconômico, dor articular, uso prévio de medicamentos imunobiológicos, atividade e tempo de doença estavam associados à variação da capacidade funcional, com capacidade explicativa de 37% de nosso modelo. Ao definir as variáveis a analisar a partir de um referencial teórico estruturado com a revisão de literatura, identificamos que nossos achados apresentaram pontos comuns com estudos realizados na Europa e América do Norte. Alguns destes achados foram: pior capacidade funcional em pacientes com mais dor e doença em atividade, em pacientes do sexo feminino e naqueles que tenham feito uso prévio de medicamento imunobiológico. Também foram relevantes as curvas em formato de J relacionadas com mais tempo de doença e pior status socioeconômico. Levantamos algumas hipóteses para os escores de incapacidade encontrados nesta população, como a adaptação dos pacientes às limitações com o avanço do tempo de doença e a percepção de que estas limitações seriam parte do envelhecimento normal. Apesar de construído a partir de uma população com mais de uma década de doença, nosso modelo incluiu variáveis comumente associadas ao componente reversível da incapacidade funcional, como dor e atividade de doença. Neste cenário, o melhor controle da doença traria benefícios aos pacientes, com recuperação de ao menos parte da capacidade funcional


Rheumatoid arthritis is an inflammatory chronic disease with estimated global prevalence of 0.5 ­ 1%, characterized by morning stiffness, joint pain and swelling. If not controlled, the disease leads to progressive joint destruction, decreasing quality of life and functional capacity. To maintain this capacity involves being able to perform basic daily life activities, such as those related with personal hygiene, to carry objects, to get dressed, to eat and to deambulate. Limitations or to be unable to perform these activities implies in at least some functional disability ­ usually measured, in rheumatoid arthritis patients, by one of the Health Assessment Questionnaire components. This dissertation's general aim was to analyze functional capacity variation, measured by the Health Assessment Questionnaire ­ Disability Index, in a Brazilian cohort of rheumatoid arthritis patients followed at outpatients clinics for a year and to create a predictive model as result of several demographic and clinical features. The specific aims were: (i) to evaluate which of the variables that were previously reported in the literature have impact on the functional capacity of RA patients in a Brazilian cohort; (ii) to build a predictive model adjusted to the Brazilian reality with variables of feasible acquisition; and (iii) to evaluate if there is effect modification due to the interaction between disease activity and length of time in the study. We evaluated 1111 rheumatoid arthritis patients followed at 11 reference treatment centers for rheumatic diseases, all pertaining to the Unified Health System ­ SUS, with prospective data collection. We applied linear mixed effects models to evaluate the variation in functional capacity, measured by Health Assessment Questionnaire ­ Disability Index, within the data collected at three time points along one year. This analysis revealed that, in the evaluated population, sex, socioeconomic status, joint pain, previous use of immunobiological drugs, disease duration and activity were associated with functional capacity variation, in a model with a 37% explanatory capacity. After defining which database variables to use from a theorical model structured with the literature review, we identified that our findings presented common aspects with studies from Europe and North America. A few of the findings were: decrease of functional capacity with pain and disease activity, in female patients and also in those with previously reported immunobiological use. Also relevant were the J-shaped curves related with longer disease duration and worse socioeconomic status. Some hypotheses for the functional capacity scores found were patient adaptability to physical limitations accrued with disease duration and perception that those limitations would be part of a normal ageing process. Though built with data from a population with more than a decade of disease duration, our model included variables commonly associated with the reversible component of functional disability, such as pain and disease activity. In this scenario, tighter control of disease activity would benefit patients and bring the possibility of regaining, at least partially, their functional capacity


Subject(s)
Humans , Arthritis, Rheumatoid/epidemiology , Quality of Life , Rheumatology , Unified Health System , Brazil , Cohort Studies , Disabled Persons , Mobility Limitation
14.
Clin. biomed. res ; 39(2): 144-151, 2019.
Article in Portuguese | LILACS | ID: biblio-1023012

ABSTRACT

Introdução: A doença tromboembólica venosa e as complicações obstétricas resultantes do tromboembolismo placentário são as principais causas de morbidade e mortalidade materna e fetal. Pode-se dizer que a gravidez é um fator independente para o desenvolvimento de trombose, já que seu risco é de 5 a 6 vezes maior em mulheres grávidas quando comparadas a não grávidas, sendo mais elevado após o parto. Métodos: Trata-se de uma coorte histórica, onde foram estudadas pacientes atendidas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora (expostos=n=70 pacientes) e na Faculdade de Medicina de Barbacena (não expostos=n=74 pacientes). As pacientes foram divididas em dois grupos: Grupo 1 = pacientes com alguma trombofilia identificada (expostos) através das dosagens de proteína S, proteína C, homocisteína, antitrombina III, mutação da MTHFR, mutação da protrombina e do fator V de Leiden; e Grupo 2 = pacientes do serviço de baixo risco obstétrico. Resultados: Houve associação entre trombofilia e aborto prévio, bem como trombofilia e morte fetal prévia (p<0,05). O tipo de trombofilia que foi associada a abortamento prévio foi o déficit da proteína S. A mutação da MTHFR foi associada aos antecedentes de HELLP síndrome (p=0,03; x2 =4,2) e de pré-eclâmpsia (p=0,03; X2 =4,5) quando em homozigotia mutante. A homozigotia para a MTHFR foi também associada às médias de homocisteína, de forma que as homozigotas eram aquelas que apresentavam a maior dosagem de homocisteína (p=0,01; X2 =5,8; X= 27,2 ± 41,2 vs. 12,62 ± 19,0). Conclusão: As trombofilias hereditárias podem estar associadas a mau desfecho obstétrico e devem ser valorizadas na clínica obstétrica. (AU)


Introduction: Venous thromboembolic disease and obstetric complications resulting from placental thromboembolism are the main causes of maternal and fetal morbidity and mortality. Pregnancy is considered an independent factor for the development of thrombosis, as its risk is 5 to 6 times greater in pregnant women when compared to non-pregnant women, being even higher after childbirth. Methods: This historical cohort included patients seen at the Obstetrics Service of Federal University of Juiz de Fora (exposed patients, n = 70) and at the School of Medicine of Barbacena (unexposed patients, n = 74). The patients were divided into two groups: Group 1 consisted of patients with some thrombophilia identified through measurement of protein S, protein C, homocysteine, antithrombin III, MTHFR mutation, prothrombin and factor V Leiden mutations; and Group 2 consisted of patients from the low obstetric risk service. Results: There was an association between thrombophilia and previous abortion, as well as thrombophilia and previous fetal death (p < 0.05). MTHFR mutation was associated with history of HELLP syndrome (p = 0.03; x2 = 4.2) and preeclampsia (p = 0.03; x2 = 4.5) when in homozygous mutation. Homozygous MTHFR was also associated with mean homocysteine levels, so that homozygotes were those with highest homocysteine levels (p = 0.01; x2 = 5.8; x = 27.2 ± 41.2 vs. 12.62 ± 19.0). Conclusions: Hereditary thrombophilias may be associated with poor obstetric outcome and should be valued at clinical obstetrics. (AU)


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Middle Aged , Cohort Studies , Thrombophilia , Placental Insufficiency/mortality , Brazil/epidemiology , Abortion, Spontaneous , Fetal Death
15.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 137-141, 2019. ilus, tab, graf
Article in English | LILACS | ID: biblio-1010196

ABSTRACT

Introduction: Preoperative temporal bone imaging studies have been routinely performed prior to cochlear implantation. Radiologists need to report these examinations with special focus on the surgeon's expectations. Objectives: To provide a basic structured format, in the form of a checklist, for reporting preoperative computed tomography (CT) and to its clinical impact on operative findings. Methods: The preoperative temporal bone CT scans of 47 patients were analyzed and reported according to the proposed checklist. Intraoperative assessment of mastoidectomy, posterior tympanotomy and round window access was done by the surgeon in a blinded fashion and were correlated with the radiological findings to assess its significance. Results: The proposed radiological checklist was reliable in assessing operative difficulty during cochlear implantation. Contracted mastoid and lower tegmen position were associated with a greater difficulty of the cortical mastoidectomy. Presence of an air cell around the facial nerve (FN) was predictive of easier facial recess access exposure. Facial nerve location and posterior external auditory canal (EAC) wall inclination were predictive of difficult round window (RW) accessibility. Conclusion: Certain parameters on the preoperative temporal bone CT scan may be useful in predicting potential difficulties encountered during the key steps involved in cochlear implant surgery (AU)


Subject(s)
Infant , Child, Preschool , Child , Adult , Temporal Bone/diagnostic imaging , Preoperative Care , Cochlear Implantation , Round Window, Ear/diagnostic imaging , Tomography, X-Ray Computed , Prospective Studies , Cohort Studies , Ear/diagnostic imaging , Checklist
16.
Rev. latinoam. enferm. (Online) ; 27: e3148, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1014199

ABSTRACT

Objetivo: avaliar a eficácia entre os questionários de qualidade de vida St. George Respiratory Questionnaire e Chronic Obstructive Pulmonary Disease Assessment Test em pacientes com doença pulmonar obstrutiva crônica a partir da análise de correlação e concordância, bem como identificar a ferramenta mais eficaz para avaliar sua qualidade de vida. Método: estudo analítico de coorte transversal com pacientes internados em um hospital espanhol para exacerbação de doença pulmonar obstrutiva crônica. A qualidade de vida relacionada à saúde foi avaliada com os dois questionários. Analisaram-se a correlação e a concordância entre ambos, bem como a consistência interna. As associações foram estabelecidas entre as variáveis clínicas e os resultados do questionário. Resultados: participaram 156 pacientes. Ambas as escalas mostram correlação e concordância entre elas e alta consistência interna. Uma maior sensibilidade do Chronic obstructive pulmonary disease Assessment Test foi observada para detectar a presença de tosse e expectoração. Conclusão: ambos os questionários têm a mesma confiabilidade e validade para medir a qualidade de vida em pacientes com doença pulmonar obstrutiva crônica aguda, sendo que o Chronic Obstructive Pulmonary Disease Assessment é mais sensível para detectar a tosse e a expectoração e com um tempo de preenchimento mais curto.


Objective: to evaluate the efficacy of quality of life questionnaires St. George Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test in patients with chronic obstructive pulmonary disease based on correlation and agreement analyses, and identify the most effective tool to assess their quality of life. Method: cross-sectional cohort study with patients hospitalized in a Spanish hospital for exacerbation of chronic obstructive pulmonary disease. Health-related quality of life was assessed with both questionnaires. The correlation and the agreement between the questionnaires were analyzed, as well as the internal consistency. Associations were established between the clinical variables and the results of the questionnaire. Results: one hundred and fifty-six patients participated in the study. The scales had a correlation and agreement between them and high internal consistency. A higher sensitivity of the Chronic Obstructive Pulmonary Disease Assessment Test was observed for the presence of cough and expectoration. Conclusion: the questionnaires have similar reliability and validity to measure the quality of life in patients with acute chronic obstructive pulmonary disease, and the Chronic Obstructive Pulmonary Disease Assessment Test is more sensitive to detect cough and expectoration and requires a shorter time to be completed.


Objetivo: evaluar la efectividad entre los cuestionarios de la calidad de vida St. George Respiratory Questionnaire y Chronic obstructive pulmonary disease Assessment Test en pacientes con enfermedad pulmonar obstructiva crónica a partir del análisis de su correlación y concordancia, e identificar la herramienta más efectiva para evaluar su calidad de vida. Método: estudio analítico transversal en pacientes ingresados en un hospital español por exacerbación de la enfermedad pulmonar obstructiva crónica. Se estudió la calidad de vida relacionada con la salud evaluada con los dos cuestionarios. Se analizó la correlación y concordancia entre ambos, así como su consistencia interna. Se establecieron asociaciones entre las variables clínicas y los resultados del cuestionario. Resultados: participaron 156 pacientes. Ambas escalas muestran correlación y concordancia entre ellas y consistencia interna elevada. Se observa una mayor sensibilidad del cuestionario Chronic obstructive pulmonary disease Assessment Test para detectar la presencia de tos y expectoración. Conclusión: ambos cuestionarios presentan la misma fiabilidad y validez para medir la calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica agudizada, siendo el Chronic obstructive pulmonary disease Assessment Test más sensible para detectar tos y expectoración y con un tiempo de cumplimentación más breve.


Subject(s)
Humans , Quality of Life , Severity of Illness Index , Reproducibility of Results , Factor Analysis, Statistical , Pulmonary Disease, Chronic Obstructive/psychology , Surveys and Questionnaires , Cohort Studies
17.
Belo Horizonte; s.n; 2019. 130 p. ilus, tab.
Thesis in English, Portuguese | LILACS, BBO - Dentistry | ID: biblio-1016561

ABSTRACT

Os objetivos deste trabalho foram 1) avaliar o impacto da terapia anticoagulante oral no sangramento associado à exodontias durante os períodos intraoperatório e pósoperatório; 2) investigar os efeitos do etexilato de dabigatrana, um inibidor direto da trombina, sobre as células ósseas. Para atender o objetivo 1, foram recrutados indivíduos em uso de anticoagulantes orais do tipo antagonista de vitamina K (AVK) e alvo-específico (DOAC, do inglês direct oral anticoagulant) e indivíduos sem terapia anticoagulante com indicação de exodontia. As exodontias foram realizadas sem a suspensão da terapia anticoagulante e parâmetros associados a desfechos hemorrágicos foram avaliados. A avaliação quantitativa do sangramento intraoperatório foi realizada por meio da mensuração do volume e análise dos fluidos aspirados durante o procedimento e normalizada por um escore. Obtivemos como resultados que as complicações hemorrágicas pós-operatórias bem como o escore de sangramento intraoperatório foi similar entre os grupos, sendo que nenhum evento hemorrágico foi observado no grupo DOAC. A história prévia de complicações hemorrágicas em procedimentos odontológicos (p=0,001) e uso de medidas hemostáticas locais (p=0,017) foram estatisticamente maiores no grupo AVK. Para atender o objetivo 2, experimentos foram conduzidos a partir de modelo in vitro, no qual o efeito da terapia anticoagulante foi avaliado diretamente sobre as células ósseas e em modelo animal ex-vivo. Neste modelo ex-vivo, células de animais previamente tratados com etexilato de dabigatrana foram diferenciadas em osteoclastos. Culturas primárias de células-tronco de camundongos e ratos foram diferenciadas em osteoclastos e osteoblastos e tratadas com o fármaco disponível comercialmente, etexilato de dabigatrana (Pradaxa® 1-6 µg/mL) bem como seu princípio ativo, dabigatrana (0,1, 0,3, 3 e 6 µg/mL). Células não expostas aos medicamentos foram utilizadas como controle. A diferenciação de osteoclastos foi inibida pelo tratamento em ambos os modelos, in vitro e ex-vivo. Paralelamente, observou-se a redução da expressão gênica e proteica do marcador Catepsina K e da atividade reabsortiva destas células. Nas culturas de osteoblastos, o tratamento inibiu a expressão gênica dos marcadores fosfatase alcalina (ALP) e osteocalcina, reduziu a atividade in situ de ALP e a deposição de matriz extracelular, indicando um efeito negativo na diferenciação dos osteoblastos. Concluiu-se que o uso de anticoagulantes orais não aumentou a ocorrência de desfechos hemorrágicos na população estudada, o que reforça a manutenção da terapia para a realização de exodontias. O tratamento sobre culturas celulares utilizando etexilato de dabigatrana impactou negativamente a diferenciação e atividade de osteoclastos e osteoblastos.(AU)


The objectives of this study were 1) to evaluate the impact of oral anticoagulant therapy on the pattern of intraoperative and postoperative bleeding in dental surgery; 2) to investigate the effects of dabigatran etexilate, a direct thrombin inhibitor, on bone cells. To fulfill objective 1, individuals undergoing oral anticoagulant therapy with vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) and individuals without anticoagulant therapy, who had indication of dental extraction were included. Dental surgery procedures were performed without interruption of anticoagulant therapy and parameters associated with hemorrhagic outcomes were evaluated. Intraoperative bleeding was evaluated by means of the measurement of the total amount of blood collected during the procedure corrected by absorbance reading and normalized by score. The results showed that the occurrence of bleeding events and the intraoperative blood loss were similar among groups and hemorrhagic episodes were not observed amongst the individuals taking DOACs. The previous history of complications in dental procedures (p=0.001) and the use of additional hemostatic measures (p=0.017) were significantly higher in the VKA group. To fulfill objective 2, experiments were conducted by means of an in vitro model in which the direct effect of anticoagulant therapy on bone cells was evaluated. An ex-vivo animal model in which cells of animals previously treated with dabigatran etexilate were differentiated was also carried out into osteoclasts. Primary cultures of mice and rats cells were differentiated into osteoclasts and osteoblasts and treated with dabigatran etexilate solution (Pradaxa® 1-6 µg/mL) and its active principle dabigatran (0.1, 0.3, 3 and 6 µg/mL). Untreated cells were used as controls and the effects of the treatment on cell viability and differentiation were evaluated. Both dabigatran etexilate and its active principle, dabigatran inhibited osteoclast differentiation and activity in vitro and in the ex-vivo model, as demonstrated by the reduction of resorption pits and cathepsin K gene and protein expression. In osteoblast cultures, dabigatran etexilate reduced the in situ alkaline phosphatase (ALP) activity, matrix mineralization and gene expression of ALP and osteocalcin. These findings indicated osteoblast inhibition. In conclusion, oral anticoagulant therapy did not result in increased bleeding outcomes in this sample, which strengthen the advocacy of the maintenance of the therapy during dental surgery. Dabigatran etexilate treatment impaired the activity and differentiation of osteoclasts and osteoblasts.(AU)


Subject(s)
Humans , Osteoblasts , Surgery, Oral , Tooth Extraction , Warfarin , Postoperative Hemorrhage , Dabigatran , Anticoagulants/therapeutic use , Cohort Studies
18.
Med. infant ; 25(4): 299-302, diciembre 2018. tab
Article in Spanish | LILACS | ID: biblio-970392

ABSTRACT

Introducción. La bacteriemia por Pseudomonas aeruginosa (PAE) en niños es infrecuente. Objetivo.Describir las características epidemiológicas, clínicas, microbiológicas y evolutivas en niños con bacteriemia por PAE. Métodos. Estudio de cohorte retrospectivo. Resultados. Se incluyeron 100 pacientes (p). La mediana de edad fue de 27 meses (RIC 6-88).Tenían enfermedad de base: 93 p (93%) y 36 de ellos estaban neutropénicos. Ochenta y cinco p (85%) habían recibido antibióticos en el último mes, 60 (60%) tuvieron procedimientos invasivos previos y 81 (81%) tuvieron internaciones previas. Ingresaron con shock séptico 42 p (42%), 56 p (56%) fueron admitidos en unidad de cuidados intensivos (UCI) y 49 (49%) requirieron ventilación mecánica (VM). La bacteriemia fue primaria en 17 p (17%); asociada a catéter en 15 p (15%) y secundaria en 68 p (68%). El foco más frecuente fue mucocutáneo, 21 p, seguido por el pulmonar, 20 p. El tratamiento empírico fue adecuado en 84 p (84%). La resistencia a uno o más grupos de antibióticos se dio en el 38% de los casos, 11% fueron multirresistentes y 15% fueron resistentes sólo a carbapenemes. Fallecieron 31 p (31%). Pseudomonas aeruginosa resistente a carbapenemes en forma exclusiva o combinada con otros antibióticos se relacionó en esta serie a exposición previa a antibióticos, (p≤0,03), tratamiento empírico inicial inadecuado (p≤0,006) y mayor mortalidad (p≤0,01), prolongación de la internación y del tiempo de tratamiento (p≤0,001)


Introduction. Pseudomonas aeruginosa (PAE) associated bacteremia is uncommon in children. Objective. To describe the epidemiological, clinical, and microbiological features and outcome in children with PAE-associated bacteremia. Methods. A retrospective cohort study. Results. 100 patients (p) were included. Median age was 27 months (IQR 6-88). Overall 93 p (93%) had an underlying disease, 36 of whom had neutropenia. Eighty-five p (85%) had received antibiotics over the previous month, 60 (60%) had undergone previous invasive procedures, and 81 (81%) had been previously admitted. Forty-two p (42%) were admitted because of septic shock, 56 p (56%) were admitted to the intensive care unit (ICU), and 49 (49%) required mechanical ventilation (MV). Seventeen p (17%) had primary bacteremia, 15 p (15%) had catheter-related bacteremia, and 68 p (68%) had secondary bacteremia. The most common focus was mucocutaneous (21 p), followed by pulmonary (20 p). Emperical treatment was adequate in 84 p (84%). Resistance to one or more groups of antibiotics was observed in 38% of the cases; 11% were multiresistant and 15% were only resistant to carbapenems. Thirty-one p (31%) died. In our series, Pseudomonas aeruginosa resistant to carbapenems only or combined with other antibiotics was associated with previous exposition to antibiotics (p≤0.03), inadequate initial emperical treatment (p≤0.006), and higher mortality (p≤0.01), and longer hospital stay and treatment duration (p≤0.001)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Pseudomonas aeruginosa/isolation & purification , Pseudomonas aeruginosa/drug effects , Pseudomonas Infections/diagnosis , Pseudomonas Infections/microbiology , Pseudomonas Infections/epidemiology , Bacteremia/microbiology , Bacteremia/mortality , Drug Resistance, Multiple, Bacterial/drug effects , Carbapenems/pharmacology , Prospective Studies , Cohort Studies , Anti-Bacterial Agents/pharmacology
19.
Rev. Hosp. Ital. B. Aires (2004) ; 38(4): 131-138, dic. 2018. tab., ilus.
Article in Spanish | LILACS | ID: biblio-1022572

ABSTRACT

Introducción: la traqueostomía es una práctica frecuente dentro de las unidades de cuidados intensivos (UCI). El proceso de decanulación y el tiempo utilizado en ella resultan de interés clínico, mientras que los factores asociados al proceso y la dificultad en dicho proceso han sido poco estudiados. Objetivos: describir características clínicas y epidemiológicas de la población en estudio y su evolución desde el momento del ingreso en la UCI hasta el alta hospitalaria. Informar la incidencia de fallo de decanulación y analizar los factores de riesgo independientes asociados a la imposibilidad de esta. Materiales y métodos: estudio observacional de cohorte retrospectivo de pacientes internados en la UCI del Hospital Italiano de San Justo Agustín Rocca que requirieron traqueostomía durante su estadía. Utilizando la historia clínica informatizada se registraron variables epidemiológicas previas al ingreso en la UCI y datos evolutivos durante la internación. El período analizado fue desde el 5 de enero de 2016 hasta el 17 de diciembre de 2017. Se utilizaron modelos de regresión logística para la evaluación de potenciales predictores. Resultados: se reclutaron 50 pacientes, y todos fueron incluidos en el presente análisis. La edad promedio fue de 66 años (desvío estándar [DE] ± 15,5) y el 66% fueron hombres. El 42% fue decanulado durante el seguimiento. La incidencia en el fallo de decanulación fue del 4,77% (intervalo de confianza [IC] 95% 0,85-22,67). La mediana de tiempo hasta la decanulación desde la desvinculación de la asistencia ventilatoria fue de 17 días. En el análisis univariado hubo diferencias estadísticamente significativas en tipo de diagnóstico de ingreso en UCI y en el alta vivo hospitalaria al comparar pacientes decanulados versus no decanulados. En el análisis multivariado de regresión logística se halló el tipo de diagnóstico de ingreso en UCI como predictor independiente de imposibilidad de decanulación. Conclusiones: el motivo de ingreso clínico en UCI fue un factor predictor independiente asociado al fracaso de la decanulación y esto, posiblemente, está relacionado con la condición clínica y el estado general al ingreso, en comparación con los pacientes que ingresaron por causas quirúrgicas. No se hallaron comorbilidades ni antecedentes que se relacionen con el fracaso de la decanulación. (AU)


Introduction: the tracheostomy remains a very common surgical procedure done in the intensive care unit (ICU). The process of decannulation is of scientific interest with its associated factors not being sufficiently studied. Objectives: to describe the clinical and epidemiological characteristics of the population and their relationship to effective decanulation. To report the cumulative incidence of decannulation failure and success. To analyze independent risk factors associated with decannulation failure. Materials and methods: the present was a retrospective cohort of adult patients in the ICU at Hospital Italiano de San Justo who required tracheostomy during their in-hospital stay. Epidemiological variables were recorded before ICU admission and during their hospital stay using data from the electronic medical record. The inclusion period was 2 years long. We used descriptive statistics and logistic regression models to compare the proportion of patients who could be decannulated versus those who could not. Results: 50 patients were enrolled in the present study. Their mean age was 66 (±15.5) years and 66% of patients were male. 21 patients (42%) achieved to be decannulated. The cumulative incidence of decannulation failure was 4.77% (95% CI: 0.85-22.87). Median time from weaning to decannulation was 17 days. In univariate analysis, statistically significant differences were found in ICU admission diagnosis (p<0.001) and hospital discharge alive (p<0.001) when comparing decannulated versus not decannulated patients. In multivariate logistic regression analysis, ICU admission diagnosis was found to be an independent predictor of decannulation failure (p<0.01). Conclusions: clinical ICU admission diagnosis was an independent predictor associated with decannulation failure. This could be related to differences in baseline morbidity and clinical condition of these patients compared with surgical patients. However, no individual morbidities or clinical conditions were found to be associated in decannulation failure. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Tracheostomy/methods , Critical Illness/epidemiology , Intensive Care Units/statistics & numerical data , Tracheostomy/adverse effects , Tracheostomy/instrumentation , Tracheostomy/mortality , Tracheostomy/rehabilitation , Tracheostomy/statistics & numerical data , Risk Factors , Cohort Studies , Critical Illness/rehabilitation , Intensive Care Units/organization & administration , Intensive Care Units/trends
20.
Rev. cuba. angiol. cir. vasc ; 19(2): 133-149, jul.-dic. 2018. ilus, graf
Article in Spanish | LILACS | ID: biblio-960336

ABSTRACT

Introducción: Las arterias elásticas se caracterizan por un comportamiento hiperelástico anisotrópico, no lineal y cuasi -incompresible, el cual depende de la contribución y distribución de los principales constituyentes. Su evaluación a través de modelos constitutivos junto con enfoques numéricos apropiados puede contribuir potencialmente al estudio de enfermedades como la aterosclerosis, así como al modelado de las intervenciones quirúrgicas o traumas por accidente. Objetivo: Valorar los modelos constitutivos que caracterizan el comportamiento biomecánico de la pared arterial para la identificación del potencial adecuado que permita la correlación de parámetros bioquímicos y mecánicos, en condiciones de daño. Métodos: Se realizó una revisión bibliográfica entre los años 2010-2016 en las bases de datos: Medline, Cochrane Library, Lilacs, así como en el meta-buscador Google. Se consultaron estudios de cohorte, prospectivos, retrospectivos, clínicos, epidemiológicos, revisiones bibliográficas y ensayos clínicos. Resultados: El modelo constitutivo anisotrópico de dos familias de fibras resulta apropiado para obtener nuevas relaciones constitutivas, que aporten más información sobre las propiedades mecánicas de las arterias bajo la influencia del descontrol metabólico generado por la acción de la diabetes mellitus, en los estadios tempranos de la aterosclerosis. Conclusiones: Los cambios en la estructura, composición y propiedades mecánicas que sufre la pared arterial, debido al descontrol metabólico, permite aseverar que la formulación de un modelo adecuado para representar esta realidad es una etapa crucial en la obtención de nuevas relaciones constitutivas, que contribuyan a una solución satisfactoria en el diagnóstico clínico no invasivo de las enfermedades vasculares(AU)


Introduction: The elastic arteries are characterized by a hyper-elastic, anisotropic, non-linear and quasi-incomprehensible behaviour, which depends on the contribution and distribution of the main constituents. Its evaluation through constitutive models together with appropriate numerical approaches can potentially contribute to the study of pathologies such as atherosclerosis, as well as to the modelling of surgical interventions or traumas by accident. Objective: To assess the constitutive models that characterize the biomechanical behavior of the arterial wall for the identification of the adequate potential that allows the correlation of biochemical and mechanical parameters in damage conditions. Methods: A bibliographic review was conducted from 2010 to 2016 in databases such as: Medline, Cochrane Library, Lilacs, as well as in the metasearch engine Google. There were consulted cohort, prospective, retrospective, clinical, epidemiological studies, bibliographic reviews and clinical trials. Results: The constitutive anisotropic model of two families of fibers is appropriate to obtain new constitutive relations, which provide of more information about the mechanical properties of the arteries under the influence of the metabolic decontrol generated by the action of diabetes mellitus, in the early stages of atherosclerosis. Conclusions: The changes in the structure, composition and mechanical properties of the arterial wall as a consequence of the metabolic decontrol allows to assert that the formulation of a suitable model to represent this reality is a crucial stage in obtaining new constitutive relations that contribute to a satisfactory solution in the non-invasive clinical diagnosis of vascular diseases(AU)


Subject(s)
Humans , Diabetic Angiopathies/complications , Epidemiology, Descriptive , Prospective Studies , Retrospective Studies , Cohort Studies
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