Influence of sedation on morbidity and mortality in the intensive care unit

CONTEXTO: Embora cerca de 30% a 50% dos pacientes hospitalizados em unidades de terapia intensiva (UTI) recebam algum tipo de sedativo, existe escassez de informações sobre efeitos adversos desta prática, especialmente no Brasil. Estes efeitos podem ser significantes e o uso de sedativos é associado a elevação de infecção e mortalidade, mesmo sendo difícil avaliar o impacto clínico deste procedimento. OBJETIVO: Avaliar o impacto da sedação sobre incidência de complicações e mortalidade em doentes graves durante internação em unidade de terapia intensiva. TIPO DE ESTUDO: Estudo prospectivo. LOCAL: Unidade de Terapia Intensiva Cirúrgica da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina. PARTICIPANTES: Após excluídos pacientes que permaneceram menos de 24 horas ou sem exames indispensáveis para o cálculo do índice de gravidade (APACHE II), restaram 307 pacientes. Estes foram divididos em dois grupos: Grupo Sedado e Grupo Não Sedado. Constatada heterogeneidade com relação ao APACHE II, foram pareados 97 sedados e 97 não sedados com idênticos índices de gravidade. VARIÁVEIS ESTUDADAS: Impacto da sedação e das técnicas sobre a mortalidade, tempo de internação, além da incidência de escara de decúbito ou pressão, trombose venosa profunda e infecção. RESULTADOS: Não houve diferença na incidência de trombose venosa profunda, entre os grupos Sedado e Não Sedado, enquanto que escara de decúbito foi significativamente maior nos sedados (p = 0,03). Infecção foi detectada em 45,4% dos pacientes com sedação e em 21,6% dos pacientes sem sedação (p = 0,006). A mortalidade para os pacientes que não receberam qualquer tipo de sedativo foi de 20,6% e, para aqueles que foram sedados durante a internação, foi de 52,6% (p < 0,0001). CONCLUSÕES: Conclui-se que a sedação está associada a maior duração da internação, morbidade e mortalidade significativas. Apesar da intensidade das associações encontradas, não é possível estabelecer relação causal entre sedação e mortalidade.

Demographic determinants of survival of people living with HIV attending an outpatient reference unit in the city of Três Lagoas, state of Mato Grosso do Sul, Brazil, in the period 1984-2009

,,,,,,,,,, While the incidence of HIV infection and AIDS is increasing in small Brazilian cities, epidemiological studies are often conducted in large urban centers. ,,,,,,,,,,,,,,,,,, Our group conducted a retrospective analysis of survival determinants among 358 patients who attended a reference unit in a small city.,,,,,,,,,,,,,,,,,,,,,,,Death risk was lower among men that had sex with men, patients with an HIV-seropositive partner, and those admitted after highly active antiretroviral therapy (HAART) was available. ,,,,,,,,,,,,,,,,,, The study documents the striking beneficial effect of HAART. The finding of other groups with improved survival may aid in the development of programmatic strategies.,,,,

THE B-FORM TO Z-FORM TRANSITION OF POLY(DG-M(5)DC) IS SENSITIVE TO NEUTRAL SOLUTES THROUGH AN OSMOTIC-STRESS

Several neutral solutes, ranging in size from methanol to a tetrasaccharide, stachyose, are shown to stabilize the left-handed Z form of the methylated polynucleotide poly(dG-m(5)dC). The action of these solutes is consistent with an osmotic stress, that is, with their effect on water chemical potentials coupled to a difference in the number of-associated water molecules between the B and Z conformations. The apparent difference in hydration between the two forms is, however, dependent on the particular solute used to probe the reaction. The effect of solutes is not consistent either with a direct binding of solute or with an indirect effect on electrostatics or ion binding through changes in the solution dielectric constant. The interplay of NaCl and neutral solute in modulating the B-Z transition suggests that salt also could be stabilizing the Z form through an osmotic stress.

Synthesis and structure of a new heteronuclear (eta(6)-arene) tricarbonylchromium compound incorporating propargyl amine unit

Reaction of equimolar amounts of [Co-2(CO)(6)(dppm)] and [Cr(eta(6)-C6H5)(C=-CCH2NMe2)(CO)(3)] (1) in benzene gives the novel heterotrimetallic complex [Cr(eta(6)-C6H5){(mu(2)-eta(2)-C=CCH2NMe2)Co-2(CO)(4)(dppm)}(CO)(3)] (2) in 40% yield. The X-ray structure analysis of 2 reveals that the Cr(CO)(3) tripod adopts a nearly anti-eclipsed conformation. (C) 2002 Elsevier B.V. B.V. All rights reserved.

A new proposal of Arithmetic Logic Unit (ALU) to work with paraconsistent annotated logic

It can be observed that the number and the complexity of the application's domains, where the Paraconsistent Annotated Logic has been used, have grown a lot in the last decade. This increase in the complexity of the application's domain is an extra challenge for the designers of such systems, once there are not suitable computer hardware to run paraconsistent systems. This work proposes a new hardware architecture for the building Paraconsistent system.

Water quality monitoring by nanostructured films in a sensing unit system

Presented here is a study about the capability of a sensing unit to detect changes in river water quality. In order to determine its accuracy, water quality was monitored at 11 points along the Veado River in Presidente Prudente, Brazil. To have a basis for comparison, a water quality index (WQI) was developed following methods previously applied in different watersheds. Results showed an accurate relationship between WQI and electric impedance readings detected by the sensing unit. Principal components analysis (PCA) was used to derive results in a form that can be correlated with WQI calculated for each sample point, which showed the potential application of this device.

Caring for organ donors: The intensive care unit nurses' view

The nursing care for patients who are pronounced brain-dead but kept alive to serve as organ donors demands technical-scientific skills and the ability to handle situations that are often in conflict with the traditional concepts of nursing care. Based on the phenomenological approach in this article, essential themes of the lived experience of caring for these patients, including the technical and specific nursing care, the relationship with organ donors and their families, and the nurses' perception of themselves in this professional situation are described. The results point to the contradictions and ambiguities of this type of nursing, especially in regards to the affective and philosophical aspects.

The Bauru Group: A continental Cretaceous unit in Brazil - Concepts based on micropaleontological, oxygen isotope and stratigraphical data

The integration of outcrop and subsurface information, including micropaleontological data, facies and sequence stratigraphic studies, and oxygen isotope analysis, allow us to present a new stratigraphic model for the Cretaceous continental deposits of the Bauru Group, Brazil. Thirty-eight fossil taxa were recovered from these deposits, including 29 species of ostracodes and 9 species of charophytes. Seven of these ostracode species and three subspecies are new and formally described here. The associations of Chara barbosai - Ilyocypris cf. riograndensis, found in the Adamantina Formation, and Amblyochara sp. - Neuquenocypris minor mineira nov. subsp., found in the Marília Formation. Ponte Alta Member, represent two distinct groups that are respectively Turonian-Santonian and Maastrichtian (probably Late Maastrichtian) in age. Therefore, a hiatus, encompassing more than 11 Ma, separates those two formations. From bottom to top, four depositional cycles were recognized in the Bauru Group in western São Paulo: cycles 1 and 2 belong to Caiuá Formation (fluvio-lacustrine and lacustrine deposits in the Presidente Prudente region), cycle 3 to the Santo Anastácio and lower Adamantina Formation (respectively fluvial and lacustrine deposits), and cycle 4 to the upper Adamantina Formation (fluvio-lacustrine facies). An erosional unconformity separates the Caiuá and Santo Anastácio Formations (between cycles 2 and 3). The Marília Formation is a distinct unit from the underlying succession; it does not occur in western São Paulo, but is found in restricted areas of São Paulo, Minas Gerais, Mato Grosso do Sul and Goiás States. During the deposition of the Bauru Group (Aptian? to Maastrichtian) the climate was hot and arid-semiarid. Shallow lakes underwent fluctuations in expansion (wet phases) and contraction (dry phases), as well as variations in salinity. During the deposition of the Adamantina Formation (Turonian-Santonian) there were long, dry periods that caused segmentation of large lakes (due to topographic irregularities in the basaltic substrate) and sometimes exposures of the lake floors; when flooded these lake floors were colonized by extensive meadows of single species of charophytes. Small ephemeral ponds, that were hydrochemically unstable and colonized by multiple species of charophytes, were the depositional sites for the marls and mudstones of Ponte Alta Member (Maastrichtian, Late Maastrichtian?). Our micropaleontological age control, combined with the Late Cretaceous ages of volcanic ashes found in the southeastern Brazil coastal basins, and the stratigraphic position of analcimites from the Jaboticabal-SP region, suggest a Late Coniacian-Santonian age for important magmatic events occurred in the interior of Brazil (north-central São Paulo State, Triângulo Mineiro, and southwestern Goiás State).

Clinical outcome in chronic myeloid leukemia after allogeneic hematopoietic stem cell transplantation: The experience of the Bone Marrow Transplantation Unit of FUNFARME/BRAZIL using FISH

Investigation of the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in chronic myeloid leukemia patients is essential to predict prognosis and survival. In 20 patients treated at the Bone Marrow Transplantation Unit of São José do Rio Preto (São Paulo, Brazil), we used fluorescence in situ hybridization (FISH) to investigate the frequency of cells with BCR/ABL rearrangement at diagnosis and at distinct intervals after allo-HSCT until complete cytogenetic remission (CCR). We investigated the disease-free survival, overall survival in 3 years and transplant-related mortality rates, too. Bone marrow samples were collected at 1, 2, 3, 4, 6, 12, and 24 months after transplantation and additional intervals as necessary. Success rate of the FISH analyses was 100%. CCR was achieved in 75% of the patients, within on average of 3.9 months; 45% patients showed CCR within 60 days after HSCT. After 3 years of the allo-HSCT, overall survival rate was 60%, disease-free survival was 50% and the transplant-related mortality rate was 40%. The study demonstrated that the BCR-ABL FISH assay is useful for follow-up of chronic myeloid leukemia patients after HSCT and that the clinical outcome parameters in our patient cohort were similar to those described for other bone marrow transplantation units. ©FUNPEC-RP.

Continuous torque system with control of the reaction unit

This article describes an orthodontic system used to obtain active continuous torque with movement control of both active and reactive units; the system relies on principles of the segmented technique. A cantilever system with .017 x .025-in beta-titanium alloy wire was designed to provide the desirable moment on the active unit. A transpalatal bar or a lingual arch increases the anchorage and neutralizes the side effects on the reactive unit. This technique is an efficient approach for major corrections of buccolingual inclinations of certain teeth. © 2010 American Association of Orthodontists.

Effect of thickness of indirect restoration and distance from the light-curing unit tip on the hardness of a dual-cured resin cement

This study evaluated the Knoop hardness and polymerization depth of a dual-cured resin cement, light-activated at different distances through different thicknesses of composite resin. One bovine incisor was embedded in resin and its buccal surface was flattened. Dentin was covered with PVC film where a mold (0.8-mm-thick and 5 mm diameter) was filled with cement and covered with another PVC film. Light curing (40 s) was carried out through resin discs (2, 3, 4 or 5 mm) with a halogen light positioned 0, 1, 2 or 3 mm from the resin surface. After storage, specimens were sectioned for hardness measurements (top, center, and bottom). Data were subjected to split-plot ANOVA and Tukey's test (α=0.05). The increase in resin disc thickness decreased cement hardness. The increase in the distance of the light curing tip decreased hardness at the top region. Specimens showed the lowest hardness values at the bottom, and the highest at the center. Resin cement hardness was influenced by the thickness of the indirect restoration and by the distance between the light-curing unit tip and the resin cement surface.

Distribution system restoration in a DG environment using a heuristic constructive multi-start algorithm

This paper proposes a heuristic constructive multi-start algorithm (HCMA) to distribution system restoration in real time considering distributed generators installed in the system. The problem is modeled as nonlinear mixed integer and considers the two main goals of the restoration of distribution networks: minimizing the number of consumers without power and the number of switching. The proposed algorithm is implemented in C++ programming language and tested using a large real-life distribution system. The results show that the proposed algorithm is able to provide a set of feasible and good quality solutions in a suitable time for the problem. © 2011 IEEE.

A class of hypergeometric polynomials with zeros on the unit circle: Extremal and orthogonal properties and quadrature formulas

The class of hypergeometric polynomials F12(-m,b;b+b̄;1-z) with respect to the parameter b=λ+iη, where λ>0, are known to have all their zeros simple and exactly on the unit circle |z|=1. In this note we look at some of the associated extremal and orthogonal properties on the unit circle and on the interval (-1,1). We also give the associated Gaussian type quadrature formulas. © 2012 IMACS.

Colonization pressure and risk factors for acquisition of imipenem-resistant Acinetobacter baumannii in a medical surgical intensive care unit in Brazil

We studied a nonconcurrent cohort of 582 patients admitted to a medical-surgical intensive care unit. Use of antimicrobials (imipenem and metronidazole) was a risk factor for acquisition of imipenem-resistant Acinetobacter baumannii only for the subcohort of patients admitted in months in which colonization pressure was lower than the median value. © 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.