RESUMO Objetivo: Estabelecer a prevalência do delirium em uma unidade de terapia intensiva geral e identificar os fatores associados, sua expressão clínica e sua influência no desfecho. Métodos: Trata-se de um estudo prospectivo de coorte em uma unidade de terapia intensiva clínico-cirúrgica. Avaliamos os pacientes diariamente, com a Richmond Agitation-Sedation Scale e a Confusion Assessment Method for the Intensive Care Unit, com o objetivo de identificar delirium nos pacientes mecanicamente ventilados. Resultados: Nesta série de casos, a prevalência de delirium foi de 184 pacientes com delirium em um total de 230 pacientes. O subtipo de delirium psicomotor foi hiperativo em 11 pacientes (6%), hipoativo em 9 (5%) e misto em 160 (89%). Uma modelagem de regressão logística múltipla, com delirium como a variável de desfecho dependente (para avaliar os fatores de risco para delirium), revelou que idade acima de 65 anos, histórico de consumo de álcool e dias em uso de ventilação mecânica foram variáveis que se associaram independentemente com o desenvolvimento de delirium. Um modelo de regressão logística múltipla, que utilizou mortalidade hospitalar como variável de desfecho dependente (para estudar os fatores de risco para óbito), mostrou que o índice de severidade da doença, como o aferido segundo o escore Acute Physiology and Chronic Health Evaluation II, o uso de ventilação mecânica por mais de 7 dias e o número de dias de sedação foram as dependentes preditoras de mortalidade hospitalar mais elevada. Conclusão: Este estudo latino-americano de coorte confirmou os fatores específicos importantes para delirium e o desfecho óbito entre pacientes admitidos a uma unidade de terapia intensiva geral. Em ambas as análises, identificamos que a duração da ventilação mecânica é um preditor de desfechos desfavoráveis.

ABSTRACT Objective: To establish the prevalence of delirium in a general intensive care unit and to identify associated factors, clinical expression and the influence on outcomes. Methods: This was a prospective cohort study in a medical surgical intensive care unit. The Richmond Agitation-Sedation Scale and Confusion Assessment Method for the Intensive Care Unit were used daily to identify delirium in mechanically ventilated patients. Results: In this series, delirium prevalence was 80% (N = 184 delirious patients out of 230 patients). The number of patients according to delirium psychomotor subtypes was as follows: 11 hyperactive patients (6%), 9 hypoactive patients (5%) and 160 mixed patients (89%). Multiple logistic regression modeling using delirium as the dependent outcome variable (to study the risk factors for delirium) revealed that age > 65 years, history of alcohol consumption, and number of mechanical ventilation days were independent variables associated with the development of delirium. The multiple logistic regression model using hospital mortality as the dependent outcome variable (to study the risk factors for death) showed that severity of illness, according to the Acute Physiology and Chronic Health Evaluation II, mechanical ventilation for more than 7 days, and sedation days were all independent predictors for excess hospital mortality. Conclusion: This Latin American prospective cohort investigation confirmed specific factors important for the development of delirium and the outcome of death among general intensive care unit patients. In both analyses, we found that the duration of mechanical ventilation was a predictor of untoward outcomes.

La infección por Streptococcus suis (S. suis) es una zoonosis emergente, poco frecuente, secundaria a la exposición alimentaria o laboral a cerdos. La infección en los humanos se considera una enfermedad emergente con aparición de casos esporádicos, y más raramente brotes. Son un importante problema en la industria porcina a nivel mundial, ya que coloniza los tractos respiratorios, digestivo y genital del ganado porcino, siendo éstos portadores asintomáticos en 80% de los casos. En el humano S. suis causa una infección sistémica que puede afectar varios órganos. La meningitis es la manifestación más frecuente (68%); con menor frecuencia puede causar sepsis (25%), artritis (12,9%), endocarditis (12,4%) y endoftalmitis (4,6%). El tratamiento de elección para la meningitis a S. suis es la penicilina. En esta comunicación se presentan los primeros dos casos de meningoencefalitis causada por S. suis en Uruguay en 2008 y 2009. Un tercer caso se reportó en Paysandú en 2009.

Infection with Streptococcus suis (S. suis) is an uncommon emerging zoonosis, secondary to food or occupational exposure to pigs. Infection in humans is considered an emerging disease with onset of sporadic cases and outbreaks rarely. They are a major problem in the swine industry worldwide since colonizes the respiratory, digestive and genital tracts of pigs, they remain asymptomatic carriers in 80% of cases. In the human S. suis causes a systemic infection that can affect various organs. Meningitis is the most common presentation (68%), less often can cause sepsis (25%), arthritis (12.9%), endocarditis (12.4%) and endophthalmitis (4.6%). The treatment of choice for S suis meningitis is penicillin. In this communication the first two cases of meningoencephalitis caused by S. suis in Uruguay in 2008 and 2009. A third case was reported in Paysandú in 2009.

The objective of this study was to evaluate the effect of a short-term supplementation with rice bran (2 kg/cows/day) on the endocrine and metabolic profiles and hepatic gene expression, associated with the reproductive response in beef cows in grazing conditions. Thirty-eight primiparous beef cows (Hereford, Angus and Hereford × Angus) were used in a randomized block design according to genotype, calving date and body condition score at calving (BCS). At 64±14 days postpartum (day 0 of the experiment), cows were assigned to two nutritional treatments: i) control, grazing native pastures (CON, n=19) and ii) supplemented (SUP, n = 19) for 21 days (days 1 to 21 of the experiment). Blood samples were collected at 0, 7 and 22 days and liver biopsies were obtained at day 22 to determine the abundance of mRNA of growth hormone receptor (GHR), insulin-like growth factor -I (IGF1), and its binding proteins -2 and -3 (IGFBP2 and IGFBP3), and insulin receptor (INSR) using SYBR-Green real-time RT-PCR with hypoxanthine phosphoribosyltransferase as endogenous control. Short-term supplementation with rice bran did not modify either cow BCS or BW, or calf BW or average daily gain. However, it decreased by 11 days the length of postpartum anestrus of primiparous cows in grazing conditions, associated with increased concentrations of glucose and insulin, and reduced hepatic expression of IGFBP2 mRNA at the end of the experimental period.