Prophylactic Melatonin for Delirium in Intensive Care (Pro-MEDIC): Study protocol for a randomised controlled trial

Background: Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium. Methods: This trial will be a multi-centre, randomised, placebo-controlled study conducted in closed ICUs in Australia. Our aim is to enrol 850 adult patients with an expected ICU length of stay (LOS) of 72h or more. Eligible patients for whom there is consent will be randomised to receive melatonin 4mg enterally or placebo in a 1:1 ratio according to a computer-generated randomisation list, stratified by site. The study drug will be indistinguishable from placebo. Patients, doctors, nurses, investigators and statisticians will be blinded. Melatonin or placebo will be administered once per day at 21:00 until ICU discharge or 14days after enrolment, whichever occurs first. Trained staff will assess patients twice daily to determine the presence or absence of delirium using the Confusion Assessment Method for the ICU score. Data will also be collected on demographics, the overall prevalence of delirium, duration and severity of delirium, sleep quality, participation in physiotherapy sessions, ICU and hospital LOS, morbidity and mortality, and healthcare costs. A subgroup of 100 patients will undergo polysomnographic testing to further evaluate the quality of sleep. Discussion: Delirium is a significant issue in ICU because of its frequency and associated poorer outcomes. This trial will be the largest evaluation of melatonin as a prophylactic agent to prevent delirium in the critically ill population. This study will also provide one of the largest series of polysomnographic testing done in ICU. Trial registration: Australian New Zealand Clinical Trial Registry (ANZCTR) number: ACTRN12616000436471. Registered on 20 December 2015

Year in review in Intensive Care Medicine, 2008: II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation

SCOPUS: re.jinfo:eu-repo/semantics/publishe

Focos de dirofilariose canina na Ilha do Marajó: um fator de risco para a saúde humana Focus of canine heartworm disease in Marajó Island, North of Brazil: a risk factor for human health

A ocorrência de dirofilariose pulmonar humana relaciona-se com a prevalência de infecção por Dirofilaria immitis na população canina. Várias espécies de mosquitos são vetores desse nematóide. Analisaram-se amostras de sangue canino coletados nas vilas Pingo d'Água e União, município de Salvaterra (Ilha do Marajó, PA), em junho, 2004 (n=34) e abril, 2005 (N=90). Os diagnósticos parasitológico e imunológico (ELISA - kit SNAP® 3DX&trade;, Biobrasil) foram comparados (chi2, alfa=0,05) no exame de 34 amostras. A prevalência na população (N=90) foi avaliada pelo ELISA. O ELISA revelou mais positivos (25/34; 73,5%) que a gota espessa (23/34, 67,6%) e o Knott (21/34, 61,8%), mas a diferença não foi significativa (p>0,05). A freqüência de infecção por D. immitis na faixa de 0 a 2 anos foi 58%, enquanto em cães mais velhos foi 100%. A prevalência da dirofilariose canina em Pingo d'Água e Vila União foi alta (53,5%), indicando risco de transmissão do parasito às pessoas nessa área.<br>The occurrence of human pulmonary dirofilariasis maintains a relation with the prevalence of Dirofilaria immitis infection in the canine population. Several mosquito species are vectors of this nematode. Canine blood samples collected in Pingo d'Água and União villages, Salvaterra municipality (Marajó Island, Pará), in June, 2004 (n=34) and April, 2005 (N=90) were analyzed. Parasitological and immunological (ELISA - kit SNAP® 3DX&trade;, Biobrasil) diagnoses were compared following the examination of 34 samples. The prevalence in the population (N=90) was evaluated by means of ELISA. ELISA revealed more positive samples (25/34; 73.5%) than thick smears (23/34, 67.6%) or Knott (21/34, 61.8%), but the differences were not significant (p>0.05). The frequency of D. immitis infection was 58% in dogs ranging from 0-2 years old, whereas in older dogs it was 100%. The prevalence of canine dirofilariasis was high in Pingo d'Água and Vila União (53.5%), indicating the risk of parasite transmission to the people in this area

Dirofilaríase pulmonar humana no Estado do Rio de Janeiro, Brasil: relato de um caso Human pulmonary dirofilariasis at Rio de Janeiro, Brazil: a case report

Relata-se caso de dirofilaríase pulmonar humana em paciente com 45 anos de idade, proveniente do Estado do Rio de Janeiro, Brasil. A radiografia torácica evidenciou nódulo pulmonar solitário localizado no lóbulo inferior esquerdo, mimetizando neoplasia. Dirofilaríase pulmonar humana deveria ser investigada em nódulos pulmonares não malignos e de etiologia não conclusiva.<br>We report a case of human pulmonary dirofilariasis in a female patient 45-years-old, derived from Rio de Janeiro, Brazil. The chest radiologic finding consisted of single pulmonary nodule located on the left lower lobe that simulated lung tumor. Human pulmonary dirofilariasis might be investigated in nodules that are not malignants and require conclusive diagnosis