938 resultados para intensive therapy unit
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Efectuou-se a análise retrospectiva de 184 dos 200 óbitos registados na UCIP do HDE, no período compreendido entre Abril de 1991 e Março de 1997. A análise efectuada visou essencialmente aspectos relacionados com o tipo de intervenção e investimento terapêutico, processo de tomada de decisão e a abordagem da morte em pediatria. A expectativa de intervenção terapêutica, à entrada, era curativa em 96 (52,2%) casos, paliativa-curativa em 44 (23,9%), paliativa não-curativa em 39 (21,2%) e de cuidados terminais em 5 (2,7%). Nos 184 casos analisados o investimento terapêutico inicial foi total em 178 (96,7%). Ao longo do internamento ocorreu uma modificação desse investimento terapêutico em 71 (38,6%) casos. Assim, dos 184 falecidos, 107 (58,2%) faleceram na sequência de reanimação cardio-respiratória não eficaz, isto é, com investimento total e 77 (41,8%) com limitação de investimento. Nestes últimos, em 19 (10,3%) casos houve diagnóstico de morte cerebral, em 47 (25,5%) decisão de não-reanimação, e em 11 limitação terapêutica.
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Artigos descrevendo o movimento assistencial de Unidades de Cuidados Intensivos Pediátricos e analisando as respectivas mortalidades não são muito comuns. Este estudo retrospectivo tem como objectivo avaliar e analisar o movimento assistencial e a mortalidade da Unidade de Cuidados Intensivos Pediátricos (UCIP) do Hospital Dona Estefania (HDE) num período de 6 anos (0.4.04.91 e 03.04.97). Neste período houve 2987 internamentos na UCIP e foram registados 200 (6.70%) óbitos, os quais corresponderam a 40.48% dos 494 6bitos verificados no HDE. A análise estatística mostrou diferenças significativas, entre sobreviventes e falecidos, relativamente aos seguintes parâmetros: índice de gravidade (4.65 vs 21.42); probabilidade de morte (3,69% vs 39.97%); grau de intervenção terapêutica (14.70 vs 34.80); idade média (4.11 vs 3.33 anos), demora média (2.70 vs 8.86 dias); incidência de doença crónica (44.73 vs 62.79%); reinternamentos(2.20 vs 16.28%) e proveniencia - Serviço de Urgência / Outros Hospitais - (51.95 vs 25.58 / 18.87 vs 39.53%). Existia doença crónica em 108 (62.79%) dos falecidos (ligeira em 27.78% e significativa em 72.22%), salientando-se a cardíaca (27.78%), a do SNC (13.89%), e a relacionada com patologia do período neonatal (10.19%). A causa final de morte relacionou-se predominantemente com patologia infecciosa (40.70%), respiratória (19.77%), cardíaca (12.21 %) e do SNC (11.63%). Existia falência mono-orgão (OSF) em 24 (13.95%) e falência múltipla de orgão (MOSF) em 148 (86.05%) dos falecidos. A mortalidade esperada era de 5.807%, tendo a mortalidade observada sido de 5.840% (Standardized Mortality Ratio = 1.006).
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Objectivo: Rever o perfil clínico e terapêutico dos doentes com malária grave admitidos numa unidade de cuidados intensivos (UCI). Tipo de estudo: Retrospectivo. População: Nove doentes com malária a Plasmodium falciparum admitidos entre Agosto de 1991 e Julho de 2001 na UCI do Hospital de Santo António dos Capuchos (HSAC). Resultados: As complicações mais frequentes foram as manifestações neurológicas, a síndroma de dificuldade respiratória aguda (SDRA) e a insuficiência renal aguda. A ventilação mecânica foi utilizada em cinco doentes, a prótese renal em dois e as aminas vasopressoras em três doentes. Faleceram dois doentes (22.2%). Conclusões: A malária a Plasmodium falciparum é uma doença potencialmente fatal, pelo que os factores de risco e os critérios para admissão em UCI devem ser identificados. A presença de disfunção de órgão, nomeadamente de manifestações neurológicas, insuficiência renal e respiratória deverão ser consideradas como indicação para internamento em cuidados intensivos.
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Incontinentia pigmenti (IP) is a rare multisystem disease, X linked dominant disorder. As all X linked dominant diseases, it is usually male-lethal. Female newborn admitted to the neonatal intensive care unit on the fi rst day of life was diagnosed as having probable herpetic infection with vesicular skin lesions distributed on upper right limb and inferior limbs. Family history showed that her 22-year-old mother had hypopigmented lesions on the lower limbs and her 13-month-old sister had hyperpigmented lesions on the trunk and limbs. In newborns, herpes infection emerges as the principal diagnosis of vesicular rash, due to the importance of precocious diagnosis and treatment. Other hypothesis must be considered in a newborn with vesicobullous rash, such as IP.
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The enzymatic modification of aminoglycosides by aminoglycoside-acetyltransferases (AAC), aminoglycoside-adenyltransferases (AAD), and aminoglycoside-phosphotransferases (APH), is the most common resistance mechanism in P. aeruginosa and these enzymes can be coded on mobile genetic elements that contribute to their dispersion. One hundred and thirty seven P. aeruginosa isolates from the University Hospital, Cumana, Venezuela (HUAPA) were evaluated. Antimicrobial susceptibility was determined by the disk diffusion method and theaac, aadB and aph genes were detected by PCR. Most of the P. aeruginosa isolates (33/137) were identified from the Intensive Care Unit (ICU), mainly from discharges (96/137). The frequency of resistant P. aeruginosaisolates was found to be higher for the aminoglycosides tobramycin and amikacin (30.7 and 29.9%, respectively). Phenotype VI, resistant to these antibiotics, was the most frequent (14/49), followed by phenotype I, resistant to all the aminoglycosides tested (12/49). The aac(6´)-Ib,aphA1 and aadB genes were the most frequently detected, and the simultaneous presence of several resistance genes in the same isolate was demonstrated. Aminoglycoside resistance in isolates ofP. aeruginosa at the HUAPA is partly due to the presence of the aac(6´)-Ib, aphA1 andaadB genes, but the high rates of antimicrobial resistance suggest the existence of several mechanisms acting together. This is the first report of aminoglycoside resistance genes in Venezuela and one of the few in Latin America.
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Background & Aims: An increased frequency of infections by multiresistant bacteria has been described in hospitalized patients. The aim of this study was to evaluate the bacterial resistance profile in cirrhotic patients. Methods: This is a retrospective observational study. We assessed the antimicrobial susceptibility of 5,839 bacterial isolates from patients with and without cirrhosis. Regarding the multidrug resistance, we evaluated 4,505 bacterial isolates from 2,180 patients. Results: Two hundred and fifty-one patients had cirrhosis (mean age 57.6 ± 11 years; 61.8% were male, 47.8% of cases associated with hepatitis C virus). Of the isolates of patients with and without cirrhosis, 174/464 (37.5%) and 1,783/4,041 (44.1%) were multiresistant, respectively (p = 0.007). E. coli was the most common multiresistant bacteria in both groups. Approximately 20% of E. coli and Klebsiella sp. isolates were ESBL-producers and 44% of S. aureus isolates were methicillin-resistant in cirrhotic patients. In cirrhotic patients admitted to the emergency department, hospital ward, and intensive care unit, 28.3%, 50% and 40% had multiresistant isolates, respectively. In patients with and without cirrhosis, 36.2% and 33.5% of isolates were resistant to third-generation cephalosporins, respectively. Conclusions: The empirical treatment of infections in hospitalized patients using broad-spectrum antibiotics should consider the observed pattern of bacterial resistance.
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Apresenta-se o movimento assistencial da Unidade de Cuidados Intensivos Polivalente (UCIP) do Hospital de Santo António dos Capuchos (HSAC), no seu ano de funcionamento (1 de Julho de 1991 a 30 de Junho de 1992). Foram internados 282 doentes, com uma idade média global de 57.91±18.16 anos e provenientes em 52.5% dos casos do Serviço de Urgência do HSAC. As principais categorias diagnósticas de admissão foram a falência cardiovascular cmlii doentes(39%) e a falência respiratória em 98 (35%); 50.7% dos doentes foram submetidos a ventilação mecânica, 44% a ecocardiografia, 13.5% a broncofibroscopia e 10.3% a monitorização hemodinâmica com catéter de Swan-Ganz. Trata-se de uma população com índices de gravidade elevados e importante mortalidade na UCIP (27.0%) e no Hospital (37.6%). Índices de gravidade,APACHEII, SAPS 1 e TISS nas primeiras 24 horas e pontuação máxima de dois índices de falência múltipla de órgão - MOF e 0SF- validados nesta população e revelaram-se como bons indicadores de prognóstico.
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Apresenta-se aqui um estudo retrospectivo de 1340 admissões por intoxicação numa Unidade de Cuidados Intensivos Polivalente durante um período de quatro anos (1986-1989). Em 666 doentes ocorreram 735 intoxicações medicamentosas e em 674 doentes 691 intoxicações não medicamentosas. Nas
intoxicações medicamentosas destacam-se os fármacos com acção principal a nível do sistema nervoso central (82.3%), predominando os insecticidas organofosforados (5 1.2%) nas não medicamentosas. Ao longo dos anos considerados constatou-se uma diminuição absoluta e relativa do número de doentes
intoxicados (480 vs 244, 15.1% vs 9.9%). Dos internados, 698 era do sexo masculino (289 nas intoxicações medicamentosas e 409 nas não medicamentosas) e 642 do sexo feminino (377 nas medicamentosas e 265 nas não medicamentosas), existindo uma diferença estatisticamente muito significativa no tipo
de intoxicação quanto ao sexo (p
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Objectives: To characterize the epidemiology and risk factors for acute kidney injury (AKI) after pediatric cardiac surgery in our center, to determine its association with poor short-term outcomes, and to develop a logistic regression model that will predict the risk of AKI for the study population. Methods: This single-center, retrospective study included consecutive pediatric patients with congenital heart disease who underwent cardiac surgery between January 2010 and December 2012. Exclusion criteria were a history of renal disease, dialysis or renal transplantation. Results: Of the 325 patients included, median age three years (1 day---18 years), AKI occurred in 40 (12.3%) on the first postoperative day. Overall mortality was 13 (4%), nine of whom were in the AKI group. AKI was significantly associated with length of intensive care unit stay, length of mechanical ventilation and in-hospital death (p<0.01). Patients’ age and postoperative serum creatinine, blood urea nitrogen and lactate levels were included in the logistic regression model as predictor variables. The model accurately predicted AKI in this population, with a maximum combined sensitivity of 82.1% and specificity of 75.4%. Conclusions: AKI is common and is associated with poor short-term outcomes in this setting. Younger age and higher postoperative serum creatinine, blood urea nitrogen and lactate levels were powerful predictors of renal injury in this population. The proposed model could be a useful tool for risk stratification of these patients.
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Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.
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Dissertação para obtenção do Grau de Mestre em Genética Molecular e Biomedicina
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Three leptospirosis cases with lung involvement are reported from the Yucatan Peninsula, Mexico. All three patients were admitted to the intensive care unit due to acute respiratory failure. Treatment with antibiotics resulted in favorable evolution despite the negative prognosis. Leptospirosis should be included in the differential diagnosis of patients with fever and lung involvement.
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INTRODUCTION: Enterobacter can be included in the group of extended spectrum β-lactamases (EBSL)-producing bacteria, though few studies exist evaluating risk factors associated with this microorganism. A retrospective cohort study was conducted to determine risk factors associated with ESBL-producing-Enterobacter and mortality METHODS: A retrospective cohort study with 58 bacteremia caused by ESBL-producing-Enterobacter (28 cases) and non-ESBL (30 cases) RESULTS: Risk factors associated with ESBL-Enterobacter were trauma, length of hospitalization, admission to the intensive care unit, urinary catheter and elective surgery (p< 0.05). The survival curves were similar for ESBL and non-ESBL CONCLUSIONS: ESBL-producing-Enterobacter bacteremia is prevalent and the survival curve was similar to non-ESBL-producing strains.
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IntroductionInsects have been described as mechanical vectors of nosocomial infections.MethodsNon-biting flying insects were collected inside a pediatric ward and neonatal-intensive care unit (ICU) of a Brazilian tertiary hospital.ResultsMost (86.4%) of them were found to carry one or more species of bacteria on their external surfaces. The bacteria isolated were Gram-positive bacilli (68.2%) or cocci (40.9%), and Gram-negative bacilli (18.2%).ConclusionsInsects collected inside a hospital were carrying pathogenic bacteria; therefore, one must consider the possibility they may act as mechanical vectors of infections, in especially for debilitated or immune-compromised patients in the hospital environments where the insects were collected.
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Introduction Methicillin-resistant Staphylococcus aureus (MRSA) strains have been responsible for many nosocomial outbreaks. Within hospitals, colonized employees often act as reservoirs for the spread of this organism. This study collected clinical samples of 91 patients admitted to the intensive care unit (ICU), hemodialysis/nephrology service and surgical clinic, and biological samples from the nasal cavities of 120 professionals working in those environments, of a University Hospital in Recife, in the State of Pernambuco, Brazil. The main objective of this study was to determine the occurrence and dissemination of methicillin- and vancomycin-resistant Staphylococcus spp. Methods The isolates obtained were tested for susceptibility to oxacillin and vancomycin and detection of the mecA gene. In addition, the isolates were evaluated for the presence of clones by ribotyping-polymerase chain reaction (PCR). Results MRSA occurrence, as detected by the presence of the mecA gene, was more prevalent among nursing technicians; 48.1% (13/27) and 40.7% (11/27) of the isolates were from health professionals of the surgical clinic. In patients, the most frequent occurrence of mecA-positive isolates was among the samples from catheter tips (33.3%; 3/9), obtained mostly from the hemodialysis/nephrology service. Eight vancomycin-resistant strains were found among the MRSA isolates through vancomycin screening. Based on the amplification patterns, 17 ribotypes were identified, with some distributed between patients and professionals. Conclusions Despite the great diversity of clones, which makes it difficult to trace the source of the infection, knowledge of the molecular and phenotypic profiles of Staphylococcus samples can contribute towards guiding therapeutic approaches in the treatment and control of nosocomial infections.