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Delirium severity and outcomes of critically ill COVID-19 patients
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Rego, Luciana Leal do

; Salluh, Jorge Ibrain Figueira

; Souza-Dantas, Vicente Cés de

; Silva, José Roberto Lapa e

; Póvoa, Pedro

; Serafim, Rodrigo Bernardo

Critical Care Science

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dec 2023, Volume 35 N. 4 Pages 394 - 401

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Objective: To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes. Methods: This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality. Results: Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty. Conclusion: In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.

RESUMO Objetivo: Investigar como a gravidade do delirium afeta pacientes graves com COVID-19 e sua associação com os desfechos. Métodos: Estudo de coorte prospectivo realizado em duas unidades de terapia intensiva terciárias no Rio de Janeiro (RJ). Os pacientes com COVID-19 foram avaliados diariamente durante os primeiros 7 dias de internação na unidade de terapia intensiva usando a escala de agitação e sedação de Richmond, a Confusion Assessment Method for Intensive Care Unit (CAM-ICU) e a Confusion Assessment Method for Intensive Care Unit-7 (CAM-ICU-7). A gravidade do delirium foi correlacionada com os desfechos e a mortalidade em 1 ano. Resultados: Entre os 277 pacientes com COVID-19 incluídos, o delirium ocorreu em 101 (36,5%) durante os primeiros 7 dias de internação na unidade de terapia intensiva e foi associado a maior tempo de internação na unidade de terapia intensiva em dias (IQ: 13 [7 - 25] versus 6 [4 - 12]; p < 0,001), maior mortalidade hospitalar (25,74% versus 5,11%; p < 0,001) e maior mortalidade em 1 ano (5,3% versus 0,6%, p < 0,001). O delirium foi classificado pela CAM-ICU-7 em termos de gravidade, e escores maiores foram associados à maior mortalidade hospitalar (17,86% versus 34,38% versus 38,46%, IC95%, valor de p < 0,001). O delirium grave foi associado a um risco maior de progressão ao coma (RC de 7,1; IC95% 1,9 - 31,0; p = 0,005) e à ventilação mecânica (RC de 11,09; IC95% 2,8 - 58,5; p = 0,002) na análise multivariada, ajustada por gravidade e fragilidade Conclusão: Em pacientes internados com COVID-19 na unidade de terapia intensiva, o delirium foi fator de risco independente para o pior prognóstico, incluindo mortalidade. A gravidade do delirium avaliada pela CAM-ICU-7 durante a primeira semana na unidade de terapia intensiva foi associada a desfechos desfavoráveis, incluindo a progressão ao coma e à ventilação mecânica.

https://doi.org/10.5935/2965-2774.20230170-en

Research, Innovation, and National Production of Strategic Inputs for Tuberculosis Elimination in Brazil: Contributions from the REDE-TB Research Innovation Brazil REDETB REDE TB
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Arcêncio, Ricardo Alexandre

; Chimara, Erica

; Silva, José Roberto Lapa e

; Croda, Julio

; Carvalho, Anna Cristina Calçada

Revista da Sociedade Brasileira de Medicina Tropical

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2023, Volume 56 elocation e0518-2023

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0037-8682-0518-2023

Thesis and dissertations examining tuberculosis in Brazil between 2013 and 2019: an overview
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Reis, Ana Júlia

; Pizzol, Juliana Lemos Dal

; Gattelli, Rúbia

; Groll, Andrea von

; Ramos, Daniela Fernandes

; Ramis, Ivy Bastos

; Kritski, Afrânio

; Silva, José Roberto Lapa e

; Silva, Pedro Eduardo Almeida da

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0198-2022

Abstract: En | Text: En | PDF: En

ABSTRACT Background: Tuberculosis (TB) remains a serious public health problem, with approximately 10 million new cases reported annually. Knowledge about the quantitative evolution of theses and dissertations (T&Ds) examining human TB in Brazil can contribute to generating strategic planning for training professionals in this field and disease control. Therefore, this study highlights the role of T&Ds on TB in national scientific disclosures. Methods: An integrative review related to TB was performed, including T&Ds produced in Brazil and completed between 2013 and 2019. Results: A total of 559,457 T&Ds were produced, of which 1,342 were associated with TB, accounting for 0.24% of the total number of T&Ds in Brazil. This was evidenced by a predominance of themes such as attention/health care, epidemiology, and TB treatment, and 80.2% of the T&Ds on TB were related to the large areas of health and biological sciences. Only 19.7% of T&Ds were associated with groups of patients considered at risk for TB, and 50.9% were produced in southeastern Brazil. The 1,342 T&Ds on TB were developed in 416 postgraduate programs linked to 121 higher education institutions (HEIs). We highlight that 72.7% of T&Ds on TB were produced in federal HEIs, 27.4% in state HEIs, and 8.5% in private HEIs. Conclusions: Strategic themes, such as TB control, require public policies that aim to increase the number of doctors and masters with expertise in TB, with geographic uniformity, and in line with the priorities for disease control.

https://doi.org/10.1590/0037-8682-0198-2022

EBUS-TBNA versus mediastinoscopy for mediastinal staging of lung cancer: a cost-minimization analysis
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Motta, João Pedro Steinhauser

; Silva, José Roberto Lapa e

; Szklo, Amir

; Steffen, Ricardo E.

Jornal Brasileiro de Pneumologia

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2022, Volume 48 N. 4 elocation e20220103

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar as diferenças de custo entre EBUS-TBNA e mediastinoscopia no estadiamento mediastinal do câncer de pulmão não pequenas células (CPNPC). Métodos: Estudo de avaliação econômica com análise de custo-minimização. Utilizamos um software de análise de decisão para a construção de um modelo de árvore de decisão para comparar os custos à jusante da mediastinoscopia, de EBUS-TBNA sem confirmação cirúrgica de resultados negativos e de EBUS-TBNA com confirmação cirúrgica de resultados negativos no estadiamento mediastinal do CPNPC. O estudo foi realizado sob a perspectiva do sistema público de saúde brasileiro. Foram considerados apenas os custos médicos diretos. Os resultados são apresentados em moeda brasileira (reais; R$) e em dólares internacionais (I$). Resultados: Na análise de caso base, a avaliação inicial com EBUS-TBNA sem confirmação cirúrgica de resultados negativos foi a estratégia menos dispendiosa (R$ 1.254/I$ 2.961) em comparação com a mediastinoscopia (R$ 3.255/I$ 7.688) e EBUS-TBNA com confirmação cirúrgica de resultados negativos (R$ 3.688/I$ 8.711). As análises de sensibilidade também mostraram que EBUS-TBNA sem confirmação cirúrgica de resultados negativos foi a estratégia menos dispendiosa. A mediastinoscopia se tornaria a estratégia menos dispendiosa se os custos com insumos hospitalares para a realização de EBUS-TBNA aumentassem mais de 300%. EBUS-TBNA com confirmação cirúrgica de resultados negativos, em comparação com a mediastinoscopia, será menos dispendiosa se a prevalência de metástase linfonodal mediastinal for ≥ 38%. Conclusões: Este estudo demonstrou que EBUS-TBNA é a estratégia menos dispendiosa para o estadiamento mediastinal invasivo do CPNPC no sistema público de saúde brasileiro.

ABSTRACT Objective: To assess cost differences between EBUS-TBNA and mediastinoscopy for mediastinal staging of non-small cell lung cancer (NSCLC). Methods: This was an economic evaluation study with a cost-minimization analysis. We used a decision analysis software program to construct a decision tree model to compare the downstream costs of mediastinoscopy, EBUS-TBNA without surgical confirmation of negative results, and EBUS-TBNA with surgical confirmation of negative results for the mediastinal staging of NSCLC. The study was conducted from the perspective of the Brazilian public health care system. Only direct medical costs were considered. Results are shown in Brazilian currency (Real; R$) and in International Dollars (I$). Results: For the base-case analysis, initial evaluation with EBUS-TBNA without surgical confirmation of negative results was found to be the least costly strategy (R$1,254/I$2,961) in comparison with mediastinoscopy (R$3,255/I$7,688) and EBUS-TBNA with surgical confirmation of negative results (R$3,688/I$8,711). The sensitivity analyses also showed that EBUS-TBNA without surgical confirmation of negative results was the least costly strategy. Mediastinoscopy would become the least costly strategy if the costs for hospital supplies for EBUS-TBNA increased by more than 300%. EBUS-TBNA with surgical confirmation of negative results, in comparison with mediastinoscopy, will be less costly if the prevalence of mediastinal lymph node metastasis is ≥ 38%. Conclusions: This study has demonstrated that EBUS-TBNA is the least costly strategy for invasive mediastinal staging of NSCLC in the Brazilian public health care system.

https://doi.org/10.36416/1806-3756/e20220103

Relationship of anti-tuberculosis drug-induced liver injury and genetic polymorphisms in CYP2E1 and GST
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Santos, Eliana Abreu

; Gonçalves, José Carlos Saraiva

; Fleury, Marcos K.

; Kritski, Afrânio L.

; Oliveira, Martha M.

; Velasque, Luciane S.

; Silva, José Roberto Lapa e

; Estrela, Rita de Cássia E.

Brazilian Journal of Infectious Diseases

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dec 2019, Volume 23 N. 6 Pages 381 - 387

Abstract: En | Text: En | PDF: En

ABSTRACT Setting: Treatment of tuberculosis (TB) can result in Drug-Induced Liver Injury (DILI) since hepatotoxic metabolites are formed during the biotransformation of isoniazid (INH).DILI can be related to the genetic profile of the patient. Single nucleotide polymorphisms in the CYP2E1 gene and GSTM1 and GSTT1 deletion polymorphisms have been associated with adverse events caused by INH. Objective: To characterize the genetic polymorphisms of CYP2E1, GSTT1 and GSTM1 in TB carriers. Design: This is an observational prospective cohort study of 45 patients undergoing treatment of TB. PCR-RFLP and multiplex-PCR were used. Results: The distribution of genotypic frequency in the promoter region (CYP2E1 gene) was: 98% wild genotype and 2% heterozygous. Intronic region: 78% wild genotype; 20% heterozygous and 2% homozygous variant. GST enzyme genes: 24% Null GSTM1 and 22% Null GSTT1. Patients with any variant allele of the CYP2E1 gene were grouped in the statistical analyses. Conclusion: Patients with the CYP2E1 variant genotype or Null GSTT1 showed higher risk of presenting DILI (p = 0.09; OR: 4.57; 95% CI: 0.75-27.6). Individuals with both genotypes had no increased risk compared to individuals with one genotype.

https://doi.org/10.1016/j.bjid.2019.09.003 366 downloads

Asthma mortality in Brazil, 1980-2012: a regional perspective
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Brito, Thaís de Sá

; Luiz, Ronir Raggio

; Silva, José Roberto Lapa e

; Campos, Hisbello da Silva

Jornal Brasileiro de Pneumologia

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oct 2018, Volume 44 N. 5 Pages 354 - 360

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Estimar as taxas de mortalidade por asma no Brasil no período de 1980-2012. Métodos: A partir dos dados do Sistema de Informações sobre Mortalidade do Ministério da Saúde, as taxas de mortalidade foram estimadas pelo cálculo de médias móveis numa perspectiva municipal que permitisse a avaliação diferenciada entre Brasil urbano, rural e intermediário (rurbano) no período de 2002-2012. As tendências foram avaliadas através de regressão linear simples. Resultados: Em média, foram notificadas 2.339 mortes anuais por asma no período estudado. A asma variou entre 53ª e 95ª causa de óbito. Houve decréscimo das taxas de mortalidade no país: 1,92/100.000 habitantes em 1980 e 1,21/100.000 habitantes em 2012. Na perspectiva municipal, as taxas caíram no Brasil urbano e rurbano, mas aumentaram no Brasil rural, exceto na faixa etária de 5-34 anos. As taxas de mortalidade caíram na população com até 24 anos e aumentaram entre os maiores de 74 anos. O coeficiente de mortalidade foi sempre superior no sexo feminino. Conclusões: As taxas de mortalidade por asma estão diminuindo no Brasil de modo discreto, sendo mais marcante na década 2002-2012. Apenas a região Nordeste teve tendência oposta. As taxas de mortalidade no Brasil urbano e rurbano tiveram comportamento de queda semelhante ao do cenário nacional, enquanto o Brasil rural teve comportamento oposto. Quando consideradas as faixas etárias, as taxas diminuíram entre os mais jovens e aumentaram entre idosos ≥ 75 anos.

ABSTRACT Objective: To estimate asthma mortality rates in Brazil for the period 1980-2012. Methods: On the basis of data from the Brazilian National Ministry of Health Mortality Database, we estimated mortality rates by calculating moving averages from a municipal perspective that would allow an evaluation differentiating between urban, rural, and intermediate (rurban) Brazil during the period 2002-2012. Trends were assessed using simple linear regression. Results: On average, 2,339 asthma-related deaths were reported per year during the study period. Asthma ranged from the 53rd to 95th leading cause of death. There was a decrease in asthma mortality rates in the country, from 1.92/100,000 population in 1980 to 1.21/100,000 population in 2012. From the municipal perspective, rates fell in urban and rurban Brazil, but increased in rural Brazil, except in the 5-34-year age group. Asthma mortality rates fell in the population under 25 years of age and increased among those over 74 years of age. Rates were always higher in females. Conclusions: Asthma mortality rates in Brazil have been decreasing slightly, with the decrease being more marked in the decade 2002-2012. Only the northeastern region of Brazil showed the opposite trend. Asthma mortality rates in urban and rurban Brazil showed a downward trend similar to that of the national scenario, whereas rural Brazil showed the opposite behavior. Analysis by age group showed that rates decreased among younger individuals and increased among the elderly aged ≥ 75 years.

https://doi.org/10.1590/s1806-37562017000000235 1834 downloads

Planejamento e compreensão da rede de terapia intensiva no Estado do Rio de Janeiro: um problema social complexo
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Goldwasser, Rosane Sonia

; Lobo, Maria Stella de Castro

; Arruda, Edilson Fernandes de

; Angelo, Simone Audrey

; Ribeiro, Eliana Claudia de Othero

; Silva, José Roberto Lapa e

Revista Brasileira de Terapia Intensiva

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sep 2018, Volume 30 N. 3 Pages 347 - 357

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Determinar o número de leitos de UTI para pacientes adultos a fim de reduzir o tempo de espera na fila e propor políticas estratégicas. Métodos: Abordagem multimetodológica: (a) quantitativa, através de séries temporais e teoria de filas, para prever a demanda e estimar o número de leitos de terapia intensiva em diferentes cenários; (b) qualitativa, através do grupo focal e análise do conteúdo, para explorar o comportamento, atitudes e as crenças dos médicos nas mudanças da saúde. Resultados: As 33.101 solicitações de internação nos 268 leitos regulados de terapia intensiva, durante 1 ano, resultaram na admissão de 25% dos pacientes, 55% abandonos da fila e 20% de óbitos. Mantidas as taxas atuais de entrada e saída da unidade de terapia intensiva, seriam necessários 628 leitos para assegurar que o tempo máximo de espera fosse de 6 horas. A redução das atuais taxas de abandono, em razão de melhora clínica ou a redução do tempo médio de permanência na unidade, diminuiria o número de leitos necessários para 471 e para 366, respectivamente. Caso se conseguissem ambos os objetivos, o número chegaria a 275 leitos. As entrevistas geraram três temas principais: o conflito do médico: a necessidade de estabelecer prioridades justas, legais, éticas e compartilhadas na tomada de decisão; o fracasso no acesso: filas invisíveis e falta de infraestrutura; o drama social: deterioração das políticas públicas e desarticulação das redes de saúde. Conclusão: A fila deve ser tratada como um problema social complexo, de origem multifatorial e que requer soluções integradas. Redimensionar o número de leitos não é a única solução. Melhorar os protocolos e prover a reengenharia das enfermarias gerais podem reduzir o tempo de permanência na unidade. É essencial consolidar as centrais de regulação para organizar a fila e fornecer os recursos disponíveis em tempo adequado, usando critérios de prioridade e trabalhando em conjunto com as pessoas envolvidas para garantir a governança clínica e a organização da rede.

ABSTRACT Objectives: To determine the optimal number of adult intensive care unit beds to reduce patient's queue waiting time and to propose policy strategies. Methods: Multimethodological approach: (a) quantitative time series and queueing theory were used to predict the demand and estimate intensive care unit beds in different scenarios; (b) qualitative focus group and content analysis were used to explore physicians' attitudes and provide insights into their behaviors and belief-driven healthcare delivery changes. Results: A total of 33,101 requests for 268 regulated intensive care unit beds in one year resulted in 25% admissions, 55% queue abandonment and 20% deaths. Maintaining current intensive care unit arrival and exit rates, there would need 628 beds to ensure a maximum wait time of six hours. A reduction of the current abandonment rates due to clinical improvement or the average intensive care unit length of stay would decrease the number of beds to 471 and 366, respectively. If both were reduced, the number would reach 275 beds. The interviews generated 3 main themes: (1) the doctor's conflict: fair, legal, ethical and shared priorities in the decision-making process; (2) a failure of access: invisible queues and a lack of infrastructure; and (3) societal drama: deterioration of public policies and health care networks. Conclusion: The queue should be treated as a complex societal problem with a multifactorial origin requiring integrated solutions. Improving intensive care unit protocols and reengineering the general wards may decrease the length of stay. It is essential to redefine and consolidate the regulatory centers to organize the queue and provide available resources in a timely manner, by using priority criteria, working with stakeholders to guarantee clinical governance and network organization.

https://doi.org/10.5935/0103-507x.20180053 2950 downloads

Impact of smoking on sputum culture conversion and pulmonary tuberculosis treatment outcomes in Brazil: a retrospective cohort study
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Cailleaux-Cezar, Michelle

; Loredo, Carla

; Silva, José Roberto Lapa e

; Conde, Marcus Barreto

Jornal Brasileiro de Pneumologia

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apr 2018, Volume 44 N. 2 Pages 99 - 105

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar o impacto do tabagismo no desfecho do tratamento da tuberculose pulmonar (TBP) e na taxa de conversão da cultura de Mycobacterium tuberculosis no escarro ao final do segundo mês de tratamento em pacientes com TBP confirmada por cultura em um local com incidência de tuberculose moderada no Brasil. Métodos: Estudo de coorte retrospectivo envolvendo pacientes com TBP diagnosticados e tratados no Instituto de Doenças do Tórax da Universidade Federal do Rio de Janeiro entre 2004 e 2012. Resultados: De 298 pacientes com diagnóstico confirmado de TBP no período do estudo, 174 foram incluídos na análise dos desfechos: 97 nunca fumaram (55,7%), 31 eram ex-tabagistas (17,8%), e 46 eram tabagistas atuais (26,5%). O tabagismo foi associado ao atraso na conversão da cultura do final do segundo mês do tratamento (risco relativo = 3,58 &091;IC95%: 1,30-9,86&093;; p = 0,01), assim como ao desfecho de tratamento não favorável (risco relativo = 6,29 &091;IC95%: 1,57-25,21&093;; p = 0,009). A associação entre tabagismo e cultura positiva ao final do segundo mês de tratamento foi estatisticamente significante entre os tabagistas atuais (p = 0.027). Conclusões: Nesta amostra, os pacientes tabagistas atuais apresentaram uma maior probabilidade de atraso na conversão da cultura após dois meses de tratamento e de desfecho de tratamento não favorável do que aqueles que nunca fumaram.

ABSTRACT Objective: To evaluate the impact of smoking on pulmonary tuberculosis (PTB) treatment outcomes and the two-month conversion rates for Mycobacterium tuberculosis sputum cultures among patients with culture-confirmed PTB in an area with a moderate incidence of tuberculosis in Brazil. Methods: This was a retrospective cohort study of PTB patients diagnosed and treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro between 2004 and 2012. Results: Of the 298 patients diagnosed with PTB during the study period, 174 were included in the outcome analysis: 97 (55.7%) were never-smokers, 31 (17.8%) were former smokers, and 46 (26.5%) were current smokers. Smoking was associated with a delay in sputum culture conversion at the end of the second month of TB treatment (relative risk = 3.58 &091;95% CI: 1.3-9.86&093;; p = 0.01), as well as with poor treatment outcomes (relative risk = 6.29 &091;95% CI: 1.57-25.21&093;; p = 0.009). The association between smoking and a positive culture in the second month of treatment was statistically significant among the current smokers (p = 0.027). Conclusions: In our sample, the probability of a delay in sputum culture conversion was higher in current smokers than in never-smokers, as was the probability of a poor treatment outcome.

https://doi.org/10.1590/s1806-37562017000000161 2021 downloads

DEMAND FORECAST AND OPTIMAL PLANNING OF INTENSIVE CARE UNIT (ICU) CAPACITY
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Angelo, Simone A.

; Arruda, Edilson F.

; Goldwasser, Rosane

; Lobo, Maria S.C.

; Salles, André

; Silva, José Roberto Lapa e

Pesquisa Operacional

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aug 2017, Volume 37 N. 2 Pages 229 - 245

Abstract: En | Text: En | PDF: En

ABSTRACT Critical Care is a medical specialty which addresses the life-saving and lifesustaining management of patients at risk of imminent death. The number of Intensive Care Unit (ICU) beds has an impact on patient’s prognosis. This paper aims to determine the optimal number of ICU beds to reduce patient’s waiting time. Time series was applied to predict demand making use of information on the daily patient’s requests for ICU beds to obtain a demand forecast by means of exponential smoothing and Box-Jenkins models, which provided the input of a Queuing model. The outputs were the optimal number of ICU beds, in different scenarios, based on demand rate and patient’s length of stay (LOS). A maximum waiting time in the queue of 6 hours was proposed and compared to government recommendation (118-353 beds). The need for ICU beds varied from 345 to 592 for a 6-hour waiting time (for a LOS of 6.5 to 11.2 days, respectively). The results show that managing demand and discharge timing could control the queue. Moreover, they also suggest that the current recommendation is inadequate for the demand.

https://doi.org/10.1590/0101-7438.2017.037.02.0229 2689 downloads

10.

Uso de biomarcadores na sepse pediátrica: revisão de literatura
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Lanziotti, Vanessa Soares

; Póvoa, Pedro

; Soares, Márcio

; Silva, José Roberto Lapa e

; Barbosa, Arnaldo Prata

; Salluh, Jorge Ibrain Figueira

Revista Brasileira de Terapia Intensiva

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dec 2016, Volume 28 N. 4 Pages 472 - 482

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A despeito dos avanços nos últimos anos, a sepse ainda é uma das principais causas de internação e mortalidade em lactentes e crianças. A presença de biomarcadores na resposta a um insulto infeccioso resulta em seu uso na triagem, no diagnóstico, no prognóstico (estratificação de risco), na monitorização da resposta terapêutica e no uso racional de antibióticos (duração adequada, por exemplo). Os estudos sobre biomarcadores na sepse em crianças são ainda relativamente escassos. Esta revisão aborda o uso de biomarcadores na sepse em pacientes pediátricos, com ênfase em proteína C-reativa, procalcitonina, interleucinas 6, 8 e 18, gelatinase dos neutrófilos humanos e proadrenomedulina, que podem ser úteis na abordagem da sepse pediátrica.

ABSTRACT Despite advances in recent years, sepsis is still a leading cause of hospitalization and mortality in infants and children. The presence of biomarkers during the response to an infectious insult makes it possible to use such biomarkers in screening, diagnosis, prognosis (risk stratification), monitoring of therapeutic response, and rational use of antibiotics (for example, the determination of adequate treatment length). Studies of biomarkers in sepsis in children are still relatively scarce. This review addresses the use of biomarkers in sepsis in pediatric patients with emphasis on C-reactive protein, procalcitonin, interleukins 6, 8, and 18, human neutrophil gelatinase, and proadrenomedullin. Assessment of these biomarkers may be useful in the management of pediatric sepsis.

https://doi.org/10.5935/0103-507x.20160080 5390 downloads

11.

Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro
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Goldwasser, Rosane Sonia

; Lobo, Maria Stella de Castro

; Arruda, Edilson Fernandes de

; Angelo, Simone Aldrey

; Silva, José Roberto Lapa e

; Salles, André Assis de

; David, Cid Marcos

Revista de Saúde Pública

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2016, Volume 50 elocation 19

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO OBJETIVO Determinar o número necessário de leitos públicos de unidades de terapia intensiva para adultos no estado do Rio de Janeiro para atender à demanda existente, e comparar os resultados com a recomendação do Ministério da Saúde. MÉTODOS Seguiu-se modelo híbrido que agrega séries temporais e teoria de filas para prever a demanda e estimar o número de leitos necessários. Foram considerados quatro cenários de fluxo de pacientes, de acordo com as solicitações de vagas, proporção de desistências e tempo médio de permanência no leito de unidade de terapia intensiva. Os resultados foram confrontados com os parâmetros do Ministério da Saúde. Os dados foram obtidos da Central Estadual de Regulação, de 2010 a 2011. RESULTADOS Houve 33.101 solicitações médicas para 268 leitos de unidade de terapia intensiva regulados no Rio de Janeiro. Com tempo médio de permanência das unidades de terapia intensiva reguladas de 11,3 dias, haveria necessidade de 595 leitos ativos para garantir a estabilidade do sistema e 628 leitos para o tempo máximo na fila de seis horas. Deduzidas as atuais taxas de desistência por melhora clínica (25,8%), estes números caem para 441 e 471. Com tempo médio de permanência de 6,5 dias, o número necessário seria de 342 e 366 leitos, respectivamente; deduzidas as taxas de desistência, de 254 e 275. O Ministério da Saúde estabelece parâmetro de 118 a 353 leitos. Embora o número de leitos regulados esteja na faixa recomendada, necessita-se incremento de 122,0% de leitos para garantir a estabilidade do sistema e de 134,0% para um tempo máximo de espera de seis horas. CONCLUSÕES O dimensionamento adequado de leitos deve considerar os motivos de limitações de acesso oportuno e a gestão do fluxo de pacientes em um cenário que associa priorização das solicitações com menor tempo médio de permanência.

ABSTRACT OBJECTIVE To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health. METHODS The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011. RESULTS There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours. CONCLUSIONS Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay.

https://doi.org/10.1590/S1518-8787.2016050005997 799 downloads

12.

Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro
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Goldwasser, Rosane Sonia

; Lobo, Maria Stella de Castro

; Arruda, Edilson Fernandes de

; Angelo, Simone Aldrey

; Silva, José Roberto Lapa e

; Salles, André Assis de

; David, Cid Marcos

Revista de Saúde Pública

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2016, Volume 50 elocation 19

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/S1518-8787.2016050005997 8474 downloads

13.

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia
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Conde, Marcus Barreto

; Melo, Fernando Augusto Fiuza de

; Marques, Ana Maria Campos

; Cardoso, Ninarosa Calzavara

; Pinheiro, Valeria Goes Ferreira

; Dalcin, Paulo de Tarso Roth

; Machado Junior, Almério

; Lemos, Antonio Carlos Moreira

; Netto, Antônio Ruffino

; Durovni, Betina

; Sant'Anna, Clemax Couto

; Lima, Dinalva

; Capone, Domenico

; Barreira, Draurio

; Matos, Eliana Dias

; Mello, Fernanda Carvalho de Queiroz

; David, Fernando Cezar

; Marsico, Giovanni

; Afiune, Jorge Barros

; Silva, José Roberto Lapa e

; Jamal, Leda Fátima

; Telles, Maria Alice da Silva

; Hirata, Mário Hiroyuki

; Dalcolmo, Margareth Pretti

; Rabahi, Marcelo Fouad

; Cailleaux-Cesar, Michelle

; Palaci, Moises

; Morrone, Nelson

; Guerra, Renata Leborato

; Dietze, Reynaldo

; Miranda, Silvana Spíndola de

; Cavalcante, Solange Cesar

; Nogueira, Susie Andries

; Nonato, Tatiana Senna Galvão

; Martire, Terezinha

; Galesi, Vera Maria Nader

; Dettoni, Valdério do Valle

Jornal Brasileiro de Pneumologia

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oct 2009, Volume 35 N. 10 Pages 1018 - 1048

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Diariamente novos artigos científicos sobre tuberculose (TB) são publicados em todo mundo. No entanto, é difícil para o profissional sobrecarregado na rotina de trabalho acompanhar a literatura e discernir o que pode e deve ser aplicado na prática diária juntos aos pacientes com TB. A proposta das "III Diretrizes para TB da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)" é revisar de forma crítica o que existe de mais recente na literatura científica nacional e internacional sobre TB e apresentar aos profissionais da área de saúde as ferramentas mais atuais e úteis para o enfrentamento da TB no nosso país. As atuais "III Diretrizes para TB da SBPT" foram desenvolvidas pela Comissão de TB da SBPT e pelo Grupo de Trabalho para TB a partir do texto das "II Diretrizes para TB da SBPT" (2004). As bases de dados consultadas foram LILACS (SciELO) e PubMed (Medline). Os artigos citados foram avaliados para determinação do nível de evidência científica, e 24 recomendações sobre TB foram avaliadas, discutidas por todo grupo e colocadas em destaque. A primeira versão das "III Diretrizes para TB da SBPT" foi colocada no website da SBPT para consulta pública durante três semanas, e as sugestões, críticas e o nível de evidência da referência científica que as embasavam foram avaliados e discutidos antes de serem incorporadas ou não ao texto final.

New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.

112639 downloads Cited 23 times in SciELO

14.

Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves
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Rabello, Eucir

; Batista, Vera Flores

; Lago, Patrícia Martins

; Alvares, Renata de Azevedo Gameiro

; Martinusso, Cesônia de Assis

; Silva, José Roberto Lapa e

Jornal Brasileiro de Pneumologia

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apr 2009, Volume 35 N. 4 Pages 343 - 350

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Analisar o lavado broncoalveolar (LBA) de vítimas de queimaduras que inalaram fumaça a fim de identificar alterações que possam estar associadas à morte ou à sobrevida. MÉTODOS: Dezoito vítimas de queimaduras faciais foram submetidas a LBA até 24 h após o evento, sendo realizadas a análise do conteúdo celular e proteico, incluindo TNF-α, HLA-DR, CD14, CD68 e iNOS. RESULTADOS: Dos 18 pacientes submetidos à broncoscopia, 8 (44,4%) morreram durante o seguimento. A média de idade dos pacientes que morreram foi significativamente maior (44,7 vs. 31,5 anos). A superfície corporal queimada foi em média de 60,1% nos pacientes que morreram e de 26,1% nos sobreviventes (p < 0,0001). Entre os 18 pacientes submetidos à broncoscopia, 11 (61,1%) apresentaram sinais endoscópicos de lesão por inalação de fumaça, e 4 (36,4%) destes faleceram. Dos 7 pacientes sem sinais de lesão por inalação de fumaça, 4 (57,1%) faleceram. A média do número de células epiteliais ciliadas no LBA dos pacientes que morreram foi significativamente maior daquela dos sobreviventes (6,6% vs. 1,4%; p = 0,03). Os demais parâmetros analisados não mostraram diferença entre os grupos. CONCLUSÕES: A superfície corporal queimada mostrou ser um fator preditivo de mortalidade. O aumento do número de células epiteliais ciliadas no LBA, denotando descamação epitelial brônquica, esteve associado à maior mortalidade de pacientes com queimaduras faciais.

OBJECTIVE: To analyze bronchoalveolar lavage (BAL) specimens of burn victims who inhaled smoke, in order to identify alterations associated with mortality or survival. METHODS: Eighteen victims of facial burns were submitted to BAL up to 24 h after the event. We investigated cell and protein content, including TNF-α, HLA-DR, CD14, CD68 and iNOS. RESULTS: Of the 18 patients submitted to bronchoscopy, 8 (44.4%) died during the follow-up period. The mean age of patients who died was significantly higher (44.7 vs. 31.5 years). On average, the patients who died had burns covering 60.1% of the total body surface area, compared with 26.1% in the survivors (p < 0.0001). Of the 18 patients submitted to bronchoscopy, 11 (61.1%) showed endoscopic signs of smoke inhalation injury, and 4 (36.4%) of those 11 died. Of the 7 patients with no signs of smoke inhalation injury, 4 (57.1%) died. The mean number of ciliated epithelial cells in the BAL fluid was significantly higher in the patients who died than in the survivors (6.6% vs. 1.4%; p = 0.03). There were no significant differences between the groups in terms of any of the other parameters evaluated. CONCLUSIONS: The total body surface area burned was a predictive factor for mortality. Increased numbers of ciliated epithelial cells in the BAL fluid, denoting bronchial epithelial desquamation, were associated with higher mortality in patients with facial burns.

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15.

Avaliação quantitativa das fibras elásticas na doença pulmonar obstrutiva crônica
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Rufino, Rogerio

; Madi, Kalil

; Souza, Heitor Siffert Pereira de

; Costa, Cláudia Henrique da

; Saito, Eduardo Haruo

; Silva, José Roberto Lapa e

Jornal Brasileiro de Pneumologia

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oct 2007, Volume 33 N. 5 Pages 502 - 509

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Quantificar fibras elásticas (FE), músculo liso (ML) e linfócitos T CD4+ e CD8+ na doença pulmonar obstrutiva crônica (DPOC) estável. MÉTODOS: Biópsias cirúrgicas foram obtidas de 15 pacientes com DPOC, 18 tabagistas sem limitação do fluxo aéreo e 14 não tabagistas. FE, ML e células T CD4+ e CD8+ foram quantificados através de métodos histológicos e imuno-histoquímicos. RESULTADOS: Não foi observada diferença estatisticamente significativa das FE nos três grupos (p > 0,05). Tanto a quantidade de FE por unidade de área pulmonar (mm²), quanto o percentual destas fibras por tecido pulmonar foram semelhantes nos três grupos. Foi encontrado aumento da quantidade de ML em pacientes com DPOC quando comparados a tabagistas (p = 0,003) e não tabagistas (p = 0,009). Houve tendência de aumento das células T CD8+ nos pacientes com DPOC. O total de células T CD4+ estava diminuído nos pacientes com DPOC quando comparados aos tabagistas (p = 0,015) e não tabagistas (p = 0,003). Observou-se fraca correlação entre estas células e a relação entre o volume expiratório forçado no primeiro segundo e a capacidade vital forçada (r² = 0,003). CONCLUSÕES: A quantidade de FE foi semelhante nos três grupos estudados. A hipertrofia/hiperplasia muscular da parede das vias aéreas foi encontrada tanto em pacientes com DPOC quanto em tabagistas, indicando que o remodelamento ocorra também nos tabagistas sem limitação do fluxo aéreo. Houve diminuição da relação CD4/CD8 em pacientes com DPOC.

OBJECTIVE: To quantify elastic fibers (EFs) and smooth muscle (SM) cells, as well as CD4+ and CD8+ T lymphocytes, in stable chronic obstructive pulmonary disease (COPD). METHODS: Surgical specimens were obtained from 15 COPD patients, 18 smokers without airflow limitation, and 14 nonsmokers. Histological and immunohistochemical methods were employed in order to quantify EFs, SM cells, CD4+ T cells, and CD8+ T cells. RESULTS: There was no significant difference in EF numbers among the three groups (p > 0.05). The number of EFs per unit area of lung tissue (mm²) and the percentage of EFs in the lung tissue were similar among the three groups. The numbers of SM cells were found to be higher in the COPD patients than in the smokers (p = 0.003) or in the nonsmokers (p = 0.009). There was a tendency toward an increase in CD8+ T-cell counts in the COPD patients. In specimens collected from the COPD patients, CD4+ T-cell counts were lower than in those collected from the smokers (p = 0.015) or from the nonsmokers (p = 0.003). There was a weak correlation between CD4+ T-cell count and the ratio of forced expiratory volume in one second to forced vital capacity (r² = 0.003). CONCLUSIONS: The EF counts were similar among the three groups. Hypertrophy/hyperplasia of airway wall SM cells was found in the COPD patients and in the smokers, indicating that airway remodeling occurs in smokers. The CD4/CD8 ratio was lower in the COPD patients.

5900 downloads Cited 1 time in SciELO

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