Preditores de injúria renal aguda e de mortalidade em uma Unidade de Terapia Intensiva

Introdução e Objetivos: Comparar características clínicas e evolução dos pacientes com e sem injúria renal aguda (IRA), avaliar a incidência, mortalidade da IRA e fatores de risco de IRA e de óbito em pacientes em uma Unidade de Terapia Intensiva (UTI). Métodos: Estudo retrospectivo que analisou 152 pacientes em uma única UTI. Avaliamos a idade, o sexo, o motivo do internamento, fatores de risco para IRA, dados laboratoriais, a necessidade de terapia renal substitutiva e a mortalidade. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA) e RIFLE foram registrados no dia de admissão na UTI. Determinamos a incidência da IRA, mortalidade e os preditores independentes de IRA e de óbito utilizando o modelo de regressão logística. Resultados: A idade média foi de 57,1 ± 20 anos e 60,1% eram masculinos. IRA não dialítica ocorreu em 81 pacientes (53,2%) e a IRA dialítica ocorreu em 19 pacientes (12,4%). A mortalidade global foi de 35,9%, enquanto que a taxa de mortalidade nos pacientes com IRA não dialítica foi de 43,2% e a dos com IRA dialítica de 84,2%. Na análise multivariada, a ventilação mecânica invasiva, a creatinina e a ureia elevadas na admissão foram fatores de risco independentes para IRA, enquanto que diagnóstico clínico, uso de ventilação mecânica invasiva, ureia e lactato aumentados e hipernatremia foram fatores de risco independentes para mortalidade na UTI. Conclusão: A incidência e a mortalidade de IRA na UTI foram elevadas neste estudo, apesar dos avanços que vêm surgindo no seu manejo.

Fatores de risco associados à lesão renal aguda em pacientes tratados com polimixina B em um hospital terciário

Resumo Introdução: O uso de polimixinas foi praticamente abandonado nos anos 1970 devido as altas taxas de nefropatia. Entretanto, foram reintroduzidas na prática médica devido a sua ação contra bactérias gram negativas resistentes a carbapenemicos. A literatura recente sugere uma taxa de nefropatia mais baixa do que a historicamente reportada. Objetivo: Determinar a incidência de nefropatia associada ao uso de polimixina utilizando os critérios de RIFLE. Métodos: Foi realizada coorte retrospectiva de todos pacientes adultos que receberam polimixina B no Hospital Nossa Senhora da Conceição de dezembro de 2010 até março de 2011. Resultados: 61 pacientes (43%) preencheram os critérios de rifle para injúria renal e 28 (13,7%) necessitaram de diálise. Preditores independentes para nefrotoxicidade foram hipotensão (OR, 2.79; CI 1.14-5.8; p = 0.006) e uso concomitante de vancomicina (OR, 2.86; CI, 1.27-6.4; p = 0.011). Conclusão: Nessa coorte retrospectiva, nefrotoxicidade (definida pelos criterios de RIFLE) ocorreu em 43% dos pacientes tratados com polimixina B. O uso concomitante de vancomicina e hipotensão foram fatores de risco independentes para desenvolvimento de nefropatia. Mais estudos são necessarios, particularmente com polimixina B, para esclarecer se as caracteristicas dessa droga e da colistina são sobreponíveis.

General regulations and orders, 1804

Bound with: The manual and platoon exercises, &c., &c. (51 p.) and: General orders and observations on the movement and field exercise of infantry (16 p.) Inscribed on front paste-down: L. Colonel Brock. Also inscribed: Maj. Genl T.A. Smith late of the 1st. Rifle Regt. Bookplate of Robert B. Taylor, Norfolk. On front flyleaf: lengthy, two-page transcription in ink, headed /Copy/Circular/ dated "Horse Guards, 25th May '07" and signed: "Harry Calvert Adjt. General.

General regulations and orders, 1804

Bound with: The manual and platoon exercises, &c., &c. (51 p.) and: General orders and observations on the movement and field exercise of infantry (16 p.) Inscribed on front paste-down: L. Colonel Brock. Also inscribed: Maj. Genl T.A. Smith late of the 1st. Rifle Regt. Bookplate of Robert B. Taylor, Norfolk. On front flyleaf: lengthy, two-page transcription in ink, headed /Copy/Circular/ dated "Horse Guards, 25th May '07" and signed: "Harry Calvert Adjt. General.

Broadside reporting the Fenian Invasion of Canada, June 2, 1866

The Fenians were a group intent on securing Irish independence from England. The movement had its origins in Ireland in1857, under the leadership of James Stephens, with the assistance of John O'Mahony, an American who had raised funds for the cause. The American branch of this movement was especially successful, having raised $500 000 and enlisting about 10 000 American Civil War veterans. The group split into two separate factions, one desiring an invasion of Canada and the other preferring an uprising in Ireland. It soon became apparent that an uprising in Ireland was not imminent, and a decision was made to invade Canada. In April, 1866, a raid was launched against New Brunswick. It proved unsuccessful, and another raid was attempted on June 1, 1866, this time in Ridgeway, near Fort Erie, Ontario. The Canadian militiamen were defeated, but the Fenians subsequently withdrew. A third incident occurred on June 7, this time at Missisquoi Bay in Quebec, when the Fenians crossed the border, remained there for 2 days, and withdrew. A failed uprising in Ireland in 1867 signaled the demise of the movement. The Fenian threat helped to promote a sense of union among Canadians and provided an incentive for Confederation.

Letter - Lieut A. Watson Sime to Col. F.C. McCordick

A letter from Lieut. A. Watson to Col. F.C. McCordick dated only July 3rd. The letter reads "My dear Col. McCordick, If you haven't already heard, you will be surprised to get this letter from me - in Germany. It happened at that awful slaughter - the 3rd battle of Ypres, & even now when I think of it all, I doubt my reality of existence. Everything was O.K at 730am on the 2nd - a little morning hate in the way of trench mortars, that was all. I had just visited a few of my guns & had passed Gen.s Mercer & Williams & their aides, Lyman Gooderham and Fraser (two latter at this camp) on the way to the -- C.M.R Bn. Head Quarters when the storm broke. It last for 5 hours & by the time the Germans came over there were few left to oppose them. By a miracle, the 15 yard bay of the front line, where I was with 6 others, was not levelled like all the rest of the line & we did our best with rifle & bomb. I got a crack on the head & 3 hours later I found myself in a waterfilled shell hole. By night I tried to crawl back & through, but at dawn was caught. Am very comfortable here & glad to have company of Col. Usher, Capt. Light Bourne, Capt. Frank Park M.O. -- CMR) & about 20 other Canadians. Hope all is well with you & 35 - Good luck & best regards to all. A. Watson Sime, Lieut. Haus 62-B OFFIZIER-KRIEGSGEFANGENLAGER Gutersloh.

Broadside reporting the Fenian Invasion of Canada, June 2, 1866

The Fenians were a group intent on securing Irish independence from England. The movement had its origins in Ireland in1857, under the leadership of James Stephens, with the assistance of John O'Mahony, an American who had raised funds for the cause. The American branch of this movement was especially successful, having raised $500 000 and enlisting about 10 000 American Civil War veterans. The group split into two separate factions, one desiring an invasion of Canada and the other preferring an uprising in Ireland. It soon became apparent that an uprising in Ireland was not imminent, and a decision was made to invade Canada. In April, 1866, a raid was launched against New Brunswick. It proved unsuccessful, and another raid was attempted on June 1, 1866, this time in Ridgeway, near Fort Erie, Ontario. The Canadian militiamen were defeated, but the Fenians subsequently withdrew. A third incident occurred on June 7, this time at Missisquoi Bay in Quebec, when the Fenians crossed the border, remained there for 2 days, and withdrew. A failed uprising in Ireland in 1867 signaled the demise of the movement. The Fenian threat helped to promote a sense of union among Canadians and provided an incentive for Confederation.

Photograph - Samuel DeVeaux Woodruff at DeVeaux Hall

21 ½ cm x 13 ½ cm photograph of Samuel DeVeaux Woodruff taken in October of 1891 at DeVeaux Hall in St. Catharines. Mr. Woodruff is carrying a rifle and has caught 6 woodcock and 2 quail. The photograph was described by R. Band of Toronto in 1977 and is included.

Photograph - Welland DeVeaux Woodruff with Welland DeVeaux Woodruff II

Black and white photograph, 19 cm x 24 cm, of Welland DeVeaux Woodruff examining a rifle with young Welland DeVeaux Woodruff II.

Tintype - William Knapp Cleveland dressed as cowboy

Tintype, 9 cm x 6 ½ cm, of William Knapp Cleveland (Julia Woodruff’s brother) described in a note at the bottom by R. Band. William is dressed in cowboy attire in front of a fence and brandishing a gun while holding a rifle. He is posing in front of a house.

Photograph - Group Return from Hunting

A photograph of a male holding a rifle by his side, with four females (varying ages) and another male is standing in the background. They are holding a long stick which is carrying their game.

Characteristics of Acute Kidney Injury in Patients Infected with the 2009 Influenza A (H1N1) Virus

Background and objectives: There have been few studies investigating acute kidney injury (AKI) in patients infected with the 2009 pandemic influenza A (H1N1) virus. Therefore, the objective of this study was to identify the factors associated with AKI in H1N1-infected patients. Design, setting, participants, & measurements: This was a study of 47 consecutive critically ill adult patients with reverse transcriptase-PCR-confirmed H1N1 infection in Brazil. Outcome measures were AKI (as defined by the Risk, Injury, Failure, Loss, and End-stage renal failure [RIFLE] criteria) and in-hospital death. Results: AKI was identified in 25 (53%) of the 47 H1N1-infected patients. AKI was associated with vasopressor use, mechanical ventilation, high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and severe acidosis as well as with higher levels of C-reactive protein and lactic dehydrogenase upon intensive care unit (ICU) admission. A nephrology consultation was requested for 16 patients (64%), and 8 (50%) required dialysis. At ICU admission, 7 (15%) of the 25 AKI patients had not yet progressed to AKI. However, by 72 hours after ICU admission, no difference in RIFLE score was found between AKI survivors and nonsurvivors. Of the 47 patients, 9 (19%) died, all with AKI. Mortality was associated with mechanical ventilation, vasopressor use, dialysis, high APACHE II score, high bilirubin levels, and a low RIFLE score at ICU admission. Conclusions: Among critically ill H1N1-infected patients, the incidence of AKI is high. In such patients, AKI is mainly attributable to shock. Clin J Am Soc Nephrol 5: 1916-1921, 2010. doi: 10.2215/CJN.00840110

Usando um voltímetro para medir tempo

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

Dosagem de NGAL no perioperatório de cirurgia bariátrica videolaparoscópica: comparação de Anestesia Venosa Total (TIVA) versus Sevoflurano

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

Efeitos da Cetamina S(+) em dose subanestésica sobre a função e a histologia renal, em modelo de isquemia e reperfusão em ratos

Pós-graduação em Anestesiologia - FMB