Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Política de cotas na Universidade Federal de Juiz de Fora (2006-2012): eficácia e eficiência

This work analyzes the results of the UFJF Policy of Quotas, from 2006 to 2012, under the aspects of efficacy (meeting the percentiles fixed by the Resolution 05/2005) and efficiency (measured by the academic performances of the students that entered UFJF in that period). Due to REUNI, vacancies in UFJF raised from 1,700 (2006) to 3,000 (2012) per year, and up to 16,6 thousands of candidates entered UFJF in this period, grouped in quotas: quota A (autodeclared negroes, egressed form public secondary schools), quota B (coming from public high schools), and quota C (private schools). The results in efficacy were not good, since the percentiles of A and B quota candidates approved were under the expected (40% of quota students, should be 50%, according to the Resolution). Grouped by course, the percentiles are nearly the same. Vacancies not occupied by A or B candidates (if they are not approved at the exams, or their quantity is less than the offered) were transfered to C candidates, that, in total, occupied 60% of the vacancies. In terms of efficiency, the percent of graduates is over 33% of C students, more than the 22% of A and B students. Among the graduates of the period, 70% are C students. In the period, circa 19% of C students and 17% of A and B students abandoned UFJF. In 2014, 48% of C students, 61% of B students and 63% of A students remained actives at the university. Non parametric statistical tests were applied on them, and the tests revealed that the IRA and the IRN of the B and C students are equivalents, but greater than the A students. The IRI, instead, showed that B students have the lower percents, followed by C students and A students. Meanwhile, the research revealed that the main factor that clearly determinates the efficiency and the scores of the students is the type of the second grade school they came from: when coming from federal public schools, their academic grades are greater than or equivalent of the private schools students. Students that come from state and city public schools have lower scores.Este trabalho analisa os resultados da Política de Cotas na UFJF, no período 2006- 2012, sob os aspectos de eficácia (atendimento às diretrizes da Resolução 05/2005) e de eficiência (medida pelo rendimento acadêmico dos ingressantes no período). Devido ao REUNI, as vagas na UFJF aumentaram de 1.700 (2006) para 3.000 (2012), por ano, e cerca de 16,6 mil candidatos ingressaram na UFJF neste período, sendo divididos em 3 grupos de cotistas: A (autodeclarados negros, vindos de escolas públicas), B (vindos de escolas públicas) e C (não cotistas). A conclusão foi que, em termos de eficácia, os resultados não foram satisfatórios: os percentuais de cotistas ingressantes ficaram abaixo do esperado (40% de cotistas ingressantes, contra 50% fixados na Resolução). Nos resultados por curso, os percentuais são muito diferentes. As vagas não ocupadas por cotistas (que não se candidataram em número suficiente ou foram reprovados no concurso) foram transferidas para os não cotistas que ocuparam 60% do total de vagas. Em termos de eficiência, o percentual de formandos foi maior entre os não cotistas (33%) do que entre os cotistas (22%); dos alunos que se formaram no período, 70% são não cotistas. O percentual de alunos que se evadiram foi de 19% (não cotistas) contra 16,5% (cotistas). Estavam ativos – permaneciam na UFJF -, em 2014, 48% dos ingressantes não cotistas, 61% de cotistas B e 63% de cotistas A. Foram feitos testes estatísticos não paramétricos entre os grupos, e verificou-se que, com referência ao IRA e ao Índice de Reprovação por Nota, cotistas B e não cotistas se equivalem, mas têm IRA superior, numérica e estatisticamente maior do que os cotistas A. No Índice de Reprovação por Infrequência, cotistas B tem os menores percentuais, seguidos dos não cotistas, e dos cotistas A, que tem os percentuais maiores. No entanto, verificou-se que o fator decisivo e determinante na avaliação da eficiência (rendimento acadêmico) é o tipo de escola do Ensino Médio, de onde vêm os ingressantes: quando vindos de escolas públicas federais tem medidas de rendimento acadêmico maiores ou equivalentes aos vindos de colégios particulares; cotistas vindos de escolas públicas estaduais e municipais tem medidas inferiores

Detection of Shiga toxigenic (STEC) and enteropathogenic (EPEC) Escherichia coli in dairy buffalo

Enteropathogenic (EPEC) and Shiga toxigenic (STEC) Escherichia coli are among the bacteria most associated with enteric diseases in man. The aims of this study were to determine the prevalence of STEC and EPEC in dairy buffalo and then characterize these isolates genetically. To determine the prevalence of these bacteria, samples were collected from the feces and milk of buffaloes. In total, 256 samples were collected in 3 samplings, of which 76 samples tested positive for either the stxl, stx2 or eae genes or a combination thereof. From the positive samples, 22 STEC and 11 atypical EPEC (aEPEC) isolates were obtained. The isolates showed 23 different genetic profiles. No profile was very frequent in STEC isolates. On the other hand, the profile eae+, ehxA+, iha+, efal+, toxB+, paa+, lpfA(0113)+ was found in 45% of the aEPEC isolates. In addition to stxl, stx2 and eae, the genes ehxA, efat saa, lpfA(0113), IPfA(0157/0I-141), IPfA(0157/0I-154), toxB and iha were present in the isolates. Serogroup 026 was found in 26% of the aEPEC. Other serogroups detected include 087, 0145, 0176 and 0179. The isolates were sensitive to almost all drugs tested and some isolates shared the same fingerprint patterns by enterobacterial repetitive intergenic consensus sequence-PCR (ERIC-PCR). The results suggest that, besides major reservoirs of STEC, buffaloes are also aEPEC reservoirs. The detection of a serogroup (026), and putative virulence genes (efal ehxA, paa and lpfA(0113)), previously associated with aEPEC isolated from humans with diarrhea in aEPEC from buffaloes should be studied further. (c) 2014 Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Hennessey Eagle

Weekly newspaper from Hennessey, Oklahoma that includes local, territorial, and national news along with advertising

Contamination of cattle carcasses by Escherichia coli shiga like toxin with high antimicrobials resistence

During processing of cattle carcasses, contamination may occurs with the transfer of microbiota of animals feaces to carcasses. This contamination many times may be by Escherichia coli carriers of virulence factor as stx and eae genes being classified as Shiga like toxin. Shiga toxin-producing Escherichia coli (STEC) is recognized wordwide as human pathogen. A survey was performed to determine the sensibility profile to several antimicrobial drugs of STEC in carcasses obtained from an abattoir in Brazil between March 2008 and August at 2009. A total of 120 STEC were isolated. All isolates were confirmed as being E. coli by their biochemical analysis and submitted to polymerase chain reaction (PCR) for detection of stx, eae and ehly genes. No strains was isolated being carriers of ehly gene. The number of isolates carriers of eae gene were 48/120. The most frequent resistance was seen against cephalothin (84.0%), streptomycin (45.0%), nalidixic acid (42.0%) and tetracycline (20.0%). Multidrug resistance (MDR) to three or more antimicrobial agents was observed in 46 (38.3%) E. coli isolates. The findings of STEC and MRD show that cattle carcasses may be a reservoir of pathogenic bacterial for the consumer public. © 2011 Academic Journals

Depressed cardiac autonomic modulation in patients with chronic kidney disease

Introduction: A dysfunctional autonomic nervous system (ANS) has also been recognized as an important mechanism contributing to the poor outcome in CKD patients, with several studies reporting a reduction in heart rate variability (HRV). Objective: Evaluate the sympathovagal balance in patients with chronic kidney disease on conservative treatment. Methods: In a cross-sectional study, patients with CKD stages 3, 4 and 5 not yet on dialysis (CKD group) and age-matched healthy subjects (CON group) underwent continuous heart rate recording during two twenty-minute periods in the supine position (pre-inclined), followed by passive postural inclination at 70° (inclined period). Power spectral analysis of the heart rate variability was used to assess the normalized low frequency (LFnu), indicative of sympathetic activity, and the normalized high frequency (HFnu), indicative of parasympathetic activity. The LFnu/HFnu ratio represented sympathovagal balance. Results: After tilting, CKD patients had lower sympathetic activity, higher parasympathetic activity, and lower sympathovagal balance than patients in the CON group. Compared to patients in stage 3, patients in stage 5 had a lower LFnu/HFnu ratio, suggesting a more pronounced impairment of sympathovagal balance as the disease progresses. Conclusion: CKD patients not yet on dialysis have reduced HRV, indicating cardiac autonomic dysfunction early in the course of CKD