RESUMO Objetivo: Avaliar aspectos clínicos e funcionais, assim como qualidade de vida de pacientes com doença pulmonar obstrutiva crônica após receberem alta da unidade de terapia intensiva à qual foram admitidos por insuficiência respiratória aguda. Métodos: Estudo prospectivo que incluiu pacientes com doença pulmonar obstrutiva crônica admitidos a duas unidades de terapia intensiva entre dezembro de 2010 e agosto de 2011, e que foram avaliados em três visitas após a alta da unidade de terapia intensiva. Incluíram-se 31 pacientes e, destes, 20 pacientes completaram o seguimento de 3 meses. Resultados: Ocorreu melhora significante dos seguintes aspectos: volume expiratório forçado em 1 segundo (L) (1,1/1,4/1,4; p = 0,019), Teste de Caminhada de 6 Minutos (m) (- /232,8/272,6; p = 0,04), escore BODE (7,5/5,0/3,8; p = 0,001), cognição avaliada com uso da escala Mini Mental State Examination (21/23,5/23,5; p = 0,008) e qualidade de vida avaliada pelo Saint George Respiratory Questionnaire (63,3/56,8/51; p = 0,02). A diferença média no escore total foi de 12,3 (entre as visitas um e três). Observaram-se diferenças clínicas importantes em relação ao escore de sintomas (18,8), escore de atividades (5,2) e escore de impacto (14,3). A maior parte dos participantes (80%) relatou que aceitaria uma nova admissão à unidade de terapia intensiva. Conclusão: Apesar da gravidade da doença, ao final do terceiro mês ocorreu uma significativa melhora clínica, funcional e de qualidade de vida. A maior parte dos pacientes aceitaria submeter-se a uma nova internação na unidade de terapia intensiva.

ABSTRACT Objective: The purpose of this study was to evaluate the clinical/functional aspects and quality of life of chronic obstructive pulmonary disease patients who were discharged after an intensive care unit admission for acute respiratory failure. Methods: This prospective study included chronic obstructive pulmonary disease patients who were admitted to two intensive care units between December of 2010 and August of 2011 and evaluated over three visits after discharge. Thirty patients were included, and 20 patients completed the three-month follow up. Results: There was a significant improvement in the following: forced expiratory flow in one second (L) (1.1/1.4/1.4; p = 0.019), six-minute walk test (m) (- /232.8 /272.6; p = 0.04), BODE score (7.5/5.0/3.8; p = 0.001), cognition measured by the Mini Mental State Examination (21/23.5/23.5; p = 0.008) and quality of life measured by the total Saint George Respiratory Questionnaire score (63.3/56.8/51, p = 0.02). The mean difference in the total score was 12.3 (between visits 1 and three). Important clinical differences were observed for the symptom score (18.8), activities score (5.2) and impact score (14.3). The majority of participants (80%) reported they would be willing to undergo a new intensive care unit admission. Conclusion: Despite the disease severity, there was a significant clinical, functional and quality of life improvement at the end of the third month. Most patients would be willing to undergo a new intensive care unit admission.

Leptospirosis is a spirochetal bacterial infection of great public health importance. It has a broad spectrum of clinical manifestations which goes from subclinical infection and self-limited anicteric febrile illness (80-90% of all cases) to icteric leptospiropirosis known as Weil's disease. This is a severe disease characterized by hemorrhage, acute renal failure and jaundice. It is uncommon for leptospirosis to present itself as a primary neurological disease. Additionally, acute pancreatitis is an unusual gastrointestinal manifestation. We report a case of leptospirosis presenting as ascending progressive leg weakness and complicating with acute pancreatitis in an adult patient treated at Hospital Universitário, Universidade Federal de Santa Catarina. The diagnosis was confirmed through ELISA-IgM antibody testing positive for leptospirosis. After antibiotic therapy and support treatment for a few weeks, total resolution of severe manifestations was achieved. Rare and unusual presentations of leptospirosis should be kept in mind in relevant epidemiological scenario.