92 resultados para Severe Sepsis

em Repositório Institucional UNESP - Universidade Estadual Paulista "Julio de Mesquita Filho"


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Even though community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) was described a decade ago, reports from Brazil are scarce and cases occurred in large urban centers. We report MRSA sepsis in a 16-year-old male from a small town and who had no history of exposure to healthcare or recent travel. After trauma during a soccer match, he presented swelling in the right thigh, which evolved in a month to cellulitis complicated by local abscess, orchitis and pneumonia. The patient presented severe sepsis, with fever and respiratory failure. Laboratory findings included blood leukocyte counts above 40,000/mm3 and thrombocytopenia. He was submitted to mechanical ventilation and therapy with vancomycin and imipenem. He had a slow but favorable response to therapy and was discharged after six weeks of hospitalization. MRSA grew from blood cultures and respiratory aspirates obtained before antimicrobial therapy. The isolate belonged to sequence type 5, spa type t311, harbored SCCmec type IV and genes for Panton-Valentine leukocidin and Enterotoxin A. The pulsed-field gel electrophoresis pattern was distinct from North American classic CA-MRSA clones. However, the sequence type and the spa type revealed that the clone belong to the same clonal complex isolated in Argentina. This is the first CA-MRSA infection reported in that region, with significant epidemiologic and clinical implications. © 2013 Elsevier Inc.

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Pós-graduação em Cirurgia Veterinária - FCAV

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Stress response is a universal mechanism developed by all organisms to deal with adverse changes in the environment, which lead to the synthesis of heat shock proteins (Hsps). In this study, the effect of moderate (41degreesC) and severe (44degreesC) heat stress on Hsp70 transcript expression pattern was investigated during chicken embryogenesis. Acute exposure to severe heat stress for one hour resulted in a fifteen-fold increase in Hsp70 mRNA levels. The return of stressed embryos to normal incubation temperature resulted in Hsp70 mRNA levels five-fold higher than control after three hours and normal levels after six hours. Moderate heat stress did not induce enhancements on Hsp70 mRNA levels. The spatial expression of Hsp70 transcripts was detected in embryos under normal incubation conditions. Whole-mount in situ hybridization analysis showed that Hsp70 transcripts were constitutively present in somite and in distinct encephalic domains (predominantly in prosencephalon and mesencephalon areas) of the chicken embryo. These results showed that Hsp70 induction is dependent on incubation temperature conditions, suggesting that early chicken embryos may induce a quick emergence response to cope with severe heat stress by increasing Hsp70 mRNA levels.

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Tomato severe rugose virus (ToSRV) is the predominant species of begomovirus in São Paulo State, Brazil, and infects primarily tomato and pepper plants. There is no information about genetic resistance of pepper to this virus, so in this work the reaction of 29 genotypes of Capsicum spp. was evaluated by inoculation of two ToSRV isolates: ToSRV-Sk (isolated from a tomato plant) and ToSRV-PJU (isolated from a pepper plant). For both isolates, two C. annuun genotypes (Catarino Cascabel - México and Silver) showed no symptoms 30 days after inoculation (d.a.i). In a second experiment, these two genotypes were evaluated for 150 d.a.i and, again, no symptoms could be observed. However, the virus was detected by RCA-PCR, indicating that both genotypes are susceptible, but less affected by ToSRV infection. Catarino Cascabel - México and Silver can be indicated for use in breeding programs for resistance of pepper to ToSRV.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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A espécie Tomato severe rugose virus (ToSRV) é a predominante em áreas de cultivo de pimentão no Estado de São Paulo. Sua ocorrência na cultura é relativamente recente de modo que não existem informações sobre os danos causados nesta cultura. Os objetivos do presente trabalho foram avaliar a produtividade e qualidade dos frutos de pimentão de três cultivares (Magda, Amanda e Rubia R) quando infectadas com o ToSRV. Verificou-se acentuada redução no número de frutos e menor crescimento das plantas, porém, o ToSRV não influenciou significativamente na massa, diâmetro e comprimento dos frutos. Os resultados obtidos até o momento permitem concluir que o ToSRV causa danos em pimentão e que há necessidade de estudos visando resistência ao ToSRV.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Background: Pulmonary rehabilitation (PR) programs are beneficial to patients with chronic obstructive pulmonary disease (COPD), and lower-extremity training is considered a fundamental component of PR. Nevertheless, the isolated effects of each PR component are not well established. Objective: We aimed to evaluate the effects of a cycle ergometry exercise protocol as the only intervention in a group of COPD patients, and to compare these results with a control group. Methods: 25 moderate-to-severe COPD patients were evaluated regarding pulmonary function, respiratory muscle strength, exercise capacity, quality of life and body composition. Patients were allocated to one of two groups: (a) the trained group (TG; n=13; 6 men) was submitted to a protocol of 24 exercise sessions on a cycle ergometer, with training intensity initially set at a heart rate (HR) close to 80% of maximal HR achieved in a maximal test, and load increase based on dyspnea scores, and (b) the control group (CG; n=12; 6 men) with no intervention during the protocol period. Results: TG showed within-group significant improvements in endurance cycling time, 6-min walking distance test, maximal inspiratory pressure and in the domain 'dyspnea' related to quality of life. Despite the within-group changes, no between-group significant differences were observed. Conclusion: In COPD patients, the results of isolated low-to-moderate intensity cycle ergometer training are not comparable to effects of multimodality and high-intensity training programs. Copyright (C) 2004 S. Karger AG, Basel.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Objectives: To study the behavior of procalcitonin and to verify whether it can be used to differentiate children with septic conditions.Methods: Children were enrolled prospectively from among those aged 28 days to 14 years, admitted between January 2004 and December 2005 to the pediatric intensive care unit at Universidade Estadual Paulista UNESP with sepsis or septic shock. The children were classified as belonging to one of two groups: the sepsis group (SG; n = 47) and the septic shock group (SSG; n = 43). Procalcitonin was measured at admission (TO) and again 12 hours later (T12h), and the results classed as: < 0.5 ng/mL = sepsis unlikely; >= 0.5 to < 2 = sepsis possible; >= 2 to < 10 = systemic inflammation and : 10 = septic shock.Results: At T0 there was a greater proportion of SSG patients than SG patients in the highest PCT class [SSG: 30 (69.7%) > SG: 14 (29.8%); p < 0.05]. The proportion of SSG patients in this highest PCT class was greater than in all other classes (>= 10 = 69.7%; >= 2 to < 10 = 18.6%; >= 0.5 to < 2 = 11.6%; < 0. 5 = 0.0%; p < 0.05). The behavior of procalcitonin at T12h was similar to at T0. The pediatric risk of mortality (PRISM) scores for the SSG patients in the highest procalcitonin class were more elevated than for children in the SG [SSG: 35.15 (40.5-28.7) vs. SG: 18.6 (21.4-10.2); p < 0.05].Conclusions: Procalcitonin allows sepsis to be differentiated from septic shock, can be of aid when diagnosing septic conditions in children and may be related to severity.

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This was a prospective study of 43 septic neonates at the NICU of the School of Medicine of Botucatu, São Paulo State University. Clinical and laboratory data of sepsis were analyzed based on outcome divided into two groups, survival and death. We calculated the discriminatory power of the relevant variables for the diagnosis of sepsis in each group, and using software for Discriminant Analysis, a function was proposed. There were 43 septic cases with 31 survivals and 12 deaths. The variables that had the highest discriminatory power were: n(o) of compromised systems, the SNAP, FiO2, and (A-a)O2. The study of these and others variables, such as birth weight, n(o) of risk factors, and pH using a Linear Discriminant Function(LDF) allowed us to identify the high-risk neonates for death with a low error rate (8.33%). The LDF was: F = 0.00043 (birth weight) + 0.30367 (n(o) of risk factors) - 0.1171 (n(o) of compromised systems) + 0.33223 (SNAP) + 2.27972 (pH) - 14.96511 (FiO2) + 0.01814 ((A-a)O2). If F > 22.77 there was high risk of death. This study suggests that the LDF at the onset of sepsis is useful for the early identification of the high-risk neonates that need special clinical and laboratory surveillance.