Injúria renal aguda em unidade de terapia intensiva: estudo prospectivo sobre a incidência, fatores de risco e mortalidade

OBJETIVO: Comparar características clínicas e evolução de pacientes com e sem injúria renal aguda adquirida em unidade de terapia intensiva geral de um hospital universitário terciário e identificar fatores de risco associados ao desenvolvimento de injúria renal aguda e à mortalidade. MÉTODOS: Estudo prospectivo observacional com 564 pacientes acompanhados diariamente durante a internação em unidade de terapia intensiva geral do Hospital das Clínicas da Faculdade de Medicina de Botucatu por 2 anos consecutivos (de maio de 2008 a maio de 2010), divididos em 2 grupos: com injúria renal aguda adquirida (G1) e sem injúria renal aguda adquirida (G2). RESULTADOS: A incidência de injúria renal aguda foi 25,5%. Os grupos diferiram quanto à etiologia da admissão em unidade de terapia intensiva (sepse: G1:41,6% x G2:24,1%, p<0,0001 e pós operatório neurológico 13,8% x 38,1%, p<0,0001), idade (56,8±15,9 x 49,8± 17,8 anos, p< 0,0001), APACHE II (21,9±6,9 x 14,1±4,6, p<0,0001), ventilação mecânica (89,2 x 69,1%, p<0,0001) e uso de drogas vasoativas (78,3 x 56,1%, p<0,0001). Com relação aos fatores de risco e às comorbidades, os grupos foram diferentes quanto à presença de diabetes mellitus, insuficiência cardíaca congestiva, insuficiência renal crônica e uso de anti-inflamatórios não hormonais (28,2 x 19,7%, p=0,03; 23,6 x 11,6%, p=0,0002, 21,5 x 11,5%, p< 0,0001 e 23,5 x 7,1%, p<0,0001, respectivamente). O tempo de internação e a mortalidade foram superiores nos pacientes que adquiriram injúria renal aguda (6,6 ± 2,7 x 12,9± 5,6 dias p<0,0001 e 62,5 x 16,4%, p<0,0001). À análise multivariada foram identificados como fatores de risco para injúria renal aguda, idade>55 anos, APACHE II>16, creatinina (cr) basal>1,2 e uso de anti-inflamatórios não hormonais (OR=1,36 IC:1,22-1,85, OR=1,2 IC:1,11-1,33, OR=5,2 IC:2,3-11,6 e OR=2,15 IC:1,1-4,2, respectivamente) e a injúria renal aguda esteve independentemente associada ao maior tempo de internação e à mortalidade (OR=1,18 IC:1,05-1,26 e OR=1,24 IC:1,09-1,99 respectivamente). À análise da curva de sobrevida, após 30 dias de internação, a mortalidade foi de 83,3% no G1 e 45,2% no G2 (p<0,0001). CONCLUSÃO: A incidência de injúria renal aguda é elevada em unidade de terapia intensiva, os fatores de riscos independentes para adquirir injúria renal aguda são idade >55 anos, APACHE II>16, Cr basal >1,2 e uso de anti-inflamatórios não hormonais e a injúria renal aguda é fator de risco independente para o maior tempo de permanência em unidade de terapia intensiva e mortalidade.

Tegu (teiu) bite: Report of human injury caused by a Teiidae lizard

Lizards of the Teiidae family are large reptiles measuring up to 2 meters long. If threatened, they can demonstrate aggressive behavior by whipping their tail and occasionally biting. Here, we report a severe injury following a Teiidae lizard bite on the right index finger of a human. There was significant soft tissue damage and an avulsion fracture of the distal phalanx. He was treated with conservative wound care and prophylactic antibiotics. He developed no evidence of secondary infection and underwent delayed skin grafting.

Flame AAS determination of metal ions in fuel ethanol after preconcentration on acid carboxymethylcellulose (CMCH)

This paper describes the preparation of acid carboxymethylcellulose (CMCH), and the results of a study on the adsorption and preconcentration (using batch and flow-through column methods) of Cd(II), Cu(II), Cr(III), Fe(III), Ni(II) and Zn(II) in ethanol medium. The adsorption capacities for each metallic ion were (in mmol g(-1)) Cd(II) = 0.92; Cu(II) = 1.45; Cr(III) = 1.70; Fe(III) = 1.60; Ni(II) = 1.30; and Zn(II) = 1.10. By means of the flow-through method, a recovery of ca. 100% of the metallic ions adsorbed in a column packed with 2 g of CMCH was found when 5.0 mL of 1.0 mol L-1 hydrochloric acid were used as eluent. An enrichment factor of 20 (100 mt solution containing 50 mu g L-1 of the metallic ions, concentrated to 5.0 mt) was obtained by this preconcentration procedure. The sorption-desorption procedure applied allowed the development of a preconcentration and Flame AAS quantification method of metallic ions in fuel ethanol at trace levels.

Nutrição mineral do mamoeiro(Carica papaya L.): IV - desenvolvimento dos frutos e exportação de nutrientes através da colheita

Os propósitos deste trabalho foram: avaliar o desenvolvimento do fruto do mamoeiro (Carica papaya L.), determinar as variações das concentrações dos nutrientes durante seu crescimento e calcular as quantidades de nutrientes exportados pela colheita dos frutos. Dentre os resultados obtidos constatou-se que, as quantidades de nutrientes exportadas através da colheita, por tonelada de frutos foram: N-1.770g- P - 220 g; K-2.120 g; Ca-350 g; Mg - 180 g; S-200g: B-989 mg; Cu-130 mg; Fe-3.364 mg; Mn -1.847 mg; Mo-8 mg e Zn-1.385 mg.

Influence of strains and defects on ferroelectric and dielectric properties of thin-film barium-strontium titanates

Pristine, W and Mn 1% doped Ba(0.6)Sr(0.4)TiO(3) epitaxial thin films grown on the LaAlO(3) substrate were deposited by pulsed laser deposition (PLD). Dielectric and ferroelectric properties were determined by the capacitance measurements and X-ray diffraction was used to determine both residual elastic strains and defect-related inhomogeneous strains-by analyzing diffraction line shifts and line broadening, respectively. We found that both elastic and inhomogeneous strains are affected by doping. This strain correlates with the change in Curie-Weiss temperature and can qualitatively explain changes in dielectric loss. To explain the experimental findings, we model the dielectric and ferroelectric properties of interest in the framework of the Landau-Ginzburg-Devonshire thermodynamic theory. As expected, an, elastic-strain contribution due to the epilayer-substrate misfit has an important influence on the free-energy. However, additional terms that correspond to the defect-related inhomogeneous strain had to be introduced to fully explain the measurements.

Design of Gaussian basis sets to the theoretical interpretation of IR-spectrum of hexaaquachromium (III) ion, tetraoxochromium (IV) ion, and tetraoxochromium (VI) ion

The Generator Coordinate Hartree-Fock (GCHF) method is employed to design 16s, 16s10p, 24s17p13d, 25s17p13d, and 26s17p Gaussian basis sets for the H ((2)S), O ((3)P), O(2-) ((1)S), Cr(3+) ((4)F), Cr(4+) ((3)F), and Cr(6+) ((1)S) atomic species. These basis sets are then contracted to (4s) for H ((2)S), (6s4p) for O ((3)P), and O(2-) ((1)S), (986p3d) for Cr(3+) ((4)F), (10s8p3d) for Cr(4+) ((3)F), and (13s7p) for Cr(6+) (1S) by a standard procedure. For evaluation of the quality of those basis sets in molecular calculations, we have accomplished studies of total and orbital (HOMO and HOMO-1) energies at the HF-Roothaan level for the molecular species of our interest. The results obtained with the contracted basis sets are compared to the values obtained with our extended basis sets and to the standard 6-311G basis set from literature. Finally, the contracted basis sets are enriched with polarization function and then utilized in the theoretical interpretation of IR-spectrum of hexaaquachromium (III) ion, [Cr(H(2)O)(6)](3+), tetraoxochromium (IV) ion, [CrO(4)](4-), and tetraoxochromium (VI) ion, [CrO(4)](2-). The respective theoretical harmonic frequencies and IR-intensities were computed at the density functional theory (DFT) level. In the DFT calculations we employed the Becke's 1988 functional using the LYP correlation functional. The comparison between the results obtained and the corresponding experimental values indicates a very good description of the IR-spectra of the molecular ions studied, and that the GCHF method is still a legitimate alternative for selection of Gaussian basis sets. (C) 2003 Elsevier B.V. All rights reserved.

A fast microwave-assisted, acid-vapor, steam-cleaning procedure for autosampler cups

A new and fast procedure is proposed for cleaning autosampler cups using acid-vapor steam-cleaning with a miniaturized assembly in a microwave-heated sealed Teflon vessel. A glass cactus-shaped holder was made to support six polyethylene autosampler cups (volume, 2.0 mt) inside a 100 mt microwave vessel. Regent-grade nitric acid was added to the vessels, and the system was heated in a microwave oven for 5 min at 300 W. Chromium was determined by graphite-furnace atomic-absorption spectrophotometry. The blank values were lower with cleaned cups compared to untreated cups (i.e., as received from supplier). The quantification limits, estimated from detection limits established with Milli-Q water, were 0.66 and 0.95 mu g Cr L-1 for cleaned and untreated auto-sampler cups, respectively. (C) 1998 Elsevier B.V. B.V. All rights reserved.

Endothelial dysfunction in DOCA-salt hypertension - Possible involvement of prostaglandin endoperoxides

The effects of the arachidonic acid metabolism inhibitors on the acetylcholine responses of aortae from control (CR) and deoxycorticosterone acetate (DOCA)-salt hypertensive (HR) rats were investigated. The acetylcholine decreased response observed in HR [relaxation (%): CR 95.5 +/- 2.7, n = 4; HR 52.0 +/- 6.3, n = 5, p < 0.05] was restored by the cyclooxygenase inhibitor piroxicam [relaxation (%): CR 99.8 +/- 0.2, n = 4; HR 86.0 +/- 4.0, n = 5] and by the thromboxane synthetase inhibitor and the thrombox ane A(2)/prostaglandin H-2 receptor antagonist ridogrel [relaxation (%): CR 92.1 +/- 4.4, n = 7; HR 93.1 +/- 2.0, n = 7] but not by the inhibitors of thromboxane synthetase, prostacyclin synthetase, cytochrome P-450 monooxygenase, and lipoxygenase. So, endoperoxide intermediates seem to be involved in the decreased endothelium-dependent relaxation to acetylcholine in DOCA-salt hypertension. (C) 1999 Elsevier B.V. All rights reserved.

Magnetic properties of spinel-type oxides NiMn2-xMexO4

New materials, based on the well-known spinel compound NiMn 2O4, have been synthesized and characterized from the magnetic point of view. The manganese cation was partially substituted in the general formula NiMn2-xMexO4, by nonmagnetic and magnetic elements, such as Me = Ga, Zn, Ni and Cr (0 × 1). Prior to the determination of their magnetic properties, the non-substituted spinel NiMn2O4 was carefully characterized and studied as a function of the oxygen stoichiometry, based on the influence of the annealing atmosphere and quenching rate. The ferrimagnetic character was observed in all samples, with a paramagnetic-to-ferromagnetic transition temperature T c stabilized at 110 K, and well defined long-range antiferromagnetic interactions at lower temperatures, which depend on the applied field and the substitute concentration. © 2006 Sociedad Chilena de Química.

Marine catfish sting causing fatal heart perforation in a fisherman

Many marine catfish have serrated bony stings (spines), which are used in defense against predators, on the dorsal and pectoral fins. While catfish-induced injuries are generally characterized by the pain associated with envenomation, the stings in some species are sufficiently long and sharp to cause severe penetrating trauma. Most injuries are to the hands of victims, commonly fishermen. We report the death of a fisherman caused by myocardial perforation from a catfish sting. To our knowledge, this is the first such description in the medical literature.

Guatemala: diferencias socioeconómicas de la mortalidad de los menores de dos años 1968-1976

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Guatemala: estimaciones y proyecciones de población, 1950-2025

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Preconcentration and determination of metal ions from fuel ethanol with a new 2,2'-dipyridylamine bonded silica

A silica surface chemically modified with [3-(2,2'-dipyridylamine) propyl] groups was prepared, characterized, and evaluated for its metal ion preconcentration in fuel ethanol. To our knowledge, we are the first authors who have reported the present modification on silica gel surface. The material was characterized using infrared spectra, scanning electronic microscopy, and 13C and 29Si solid-state NMR spectra. Batch and column experiments were conducted to investigate for metal ion removal from fuel ethanol. The results showed that the Langmuir model describes the sorption equilibrium data of the metal ions in a satisfactory way. From the Langmuir isotherms, the following maximum adsorption capacities (in mmolg -1) were determined: 1.81 for Fe(III), 1.75 for Cr(III), 1.30 for Cu(II), 1.25 for Co(II), 1.15 for Pb(II), 0.95 for Ni(II), and 0.87 for Zn(II). Thermodynamic functions, the change of free energy (ΔG), enthalpy (ΔH), and entropy (ΔS) showed that the adsorption of metal ions onto Si-Pr-DPA was feasible, spontaneous, and endothermic. The sorption-desorption of the metal ions made possible the development of a preconcentration and quantification method of metal ions in fuel ethanol. © 2012 Elsevier Inc.

Análise multielementar da mucosa gástrica de roedores tratados com Alchornea glandulosa, Davilla elliptica e Davilla nitida pela técnica de fluorescência de raios-x por reflexão total

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Projeto e análise térmica de tanques de resfriamento de leite de cabra in natura para quatro ordenhas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)