1,461 research outputs found
Transthoracic Echocardiography for Evaluation of Hypotensive Critically Ill Patient
Objectivo e desenho: estudo prospectivo de avaliação da possibilidade de aplicação e
utilidade clínica da ecocardiografia transtorácica (ETT) na avaliação da hpotensão
numa Unidade de Cuidados Intensivos Polivalente (UCIP).
Local: UCIP de 16 camas.
Material e métodos: Incluídos doentes com hipotensão (pressão arterial sistólica 90
mmHg ou média (PAM) < 60 mmHg, que não respondeu à administração de soros no
espaço de 30 minutos). Os objectivos do ETT foram: excluir cardiopatia estrutural
grave, avaliação de outras alterações cardíacas (alterações das dimensões das
cavidades e função ventricular esquerda), análise da veia cava inferior (VCI) e
determinação do índex cardíaco (IC).
Resultados: de um total de 208 doentes foram incluídos 198 (4,5% de exames impossíveis), com média etária de 63,4 +/- 16,2 anos, 129 do sexo masculino, APACHE II 30,1 +/- 9,9, SAPS II 68,8 +/- 20,5, SOFA 11,6 +/- 3,8 MODS 10,9 +/- 3,9. Observou-se uma mortalidade de 51% (n=101), e 168 (85,2%) doentes estavam ventilados. Oitenta e
oito (44,4%) doentes apresentaram alterações cardíacas, dos quais 28 (14%) classificadas
como graves: três valvulopatias aórticas graves, quatro endocardites, nove
miocardiopatias dilatadas, dois tamponamentos (18 doentes com alterações graves insuspeitas, 9%), seis enfartes agudos do miocárdio, quatro alterações da cinética segmentar. Estes doentes apresentaram uma mortalidade e índices de gravidade mais elevados (p <0,001). Em relação ao IC, 157 doentes apresentaram um valor normal ou elevado, os quais apresentaram todos um valor de resistências ventriculares periféricas baixo. Por análise de regressão logística, verificou-se uma relação entre o índex da VCI e os dias de internamento (p = 0,05) e entre o IC, índex da VCI e a mortalidade (p =0,008 e 0,041 respectivamente).
Conclusões: Observou-se uma elevada prevalência de patologia cardíaca entre os
doentes admitidos numa UCIP com hipotensão (n =88, 44,4%), dos quais 14% consideradas graves. Estes doentes tiveram maior mortalidade e índices de gravidade mais elevados. A análise conjunta do IC e da VCI pode ser útil na definição do padrão
hemodinâmico do doente hipotenso e certos parâmetros ecocardiográficos, em especial
o índex da VCI, podem ser úteis no prognóstico destes doentes
Routine Transthoracic Echocardiography in a General Intensive Care Unit: an 18 Month Survey in 704 Patients
The authors analyzed 704 transthoracic echocardiographic (TTE) examinations, performed routinely to all admitted patients to a general 16-bed Intensive Care Unit (ICU) during an 18-month period. Data acquisition and prevalence of abnormalities of cardiac structures and function were assessed, as well as the new, previously unknown severe diagnoses. A TTE was performed within the first 24 h of admission on 704 consecutive patients, with a mean age of 61.5+/-17.5 years, ICU stay of 10.6+/-17.1 days, APACHE II 22.6+/-8.9, and SAPS II 52.7+/-20.4. In four patients, TTE could not be performed. Left ventricular (LV) dimensions were quantified in 689 (97.8%) patients, and LV function in 670 (95.2%) patients. Cardiac output (CO) was determined in 610 (86.7%), and mitral E/A in 399 (85.9% of patients in sinus rhythm). Echocardiographic abnormalities were detected in 234 (33%) patients, the most common being left atrial (LA) enlargement (n=163), and LV dysfunction (n=132). Patients with these alterations were older (66+/-16.5 vs 58.1+/-17.4, p<0.001), presented a higher APACHE II score (24.4+/-8.7 vs 21.1+/-8.9, p<0.001), and had a higher mortality rate (40.1% vs 25.4%, p<0.001). Severe, previously unknown echocardiographic diagnoses were detected in 53 (7.5%) patients; the most frequent condition was severe LV dysfunction. Through a multivariate logistic regression analysis, it was determined that mortality was affected by tricuspid regurgitation (p=0.016, CI 1.007-1.016) and ICU stay (p<0.001, CI 1-1.019). We conclude that TTE can detect most cardiac structures in a general ICU. One-third of the patients studied presented cardiac structural or functional alterations and 7.5% severe previously unknown diagnoses
Cardiac Doppler Variation with Volume Status Changes in General Intensive Care
Num grupo de 64 doentes de uma Unidade
de Cuidados Intensivos, 24 dos quais
submetidos a ventilação mecânica, foi
determinada a influência da modificação da
volémia nas características do Doppler
cardíaco, através da negativização do
balanço hídrico e correspondente
modificação da pressão venosa central.
Com a modificação da volémia, a relação
E/A do fluxo transvalvular mitral mostrou
uma tendência para reduzir, o tempo de
desaceleração da onda E mitral para
diminuir, o tempo de relaxamento
isovolumétrico para aumentar, e a veia cava
inferior reduziu o seu diâmetro expiratório e
aumentou o valor do colapso inspiratório.
Não se observou uma correlação significativa
entre os valores das variáveis estudadas e a
modificação da volémia, inclusivamente
entre a pressão venosa central e o balanço
hídrico.
A modificação da volémia em doentes
críticos modifica as características de
determinados parâmetros de ecocardiografia-
-Doppler, mas não é possível predizer a
magnitude dessa variação
Parâmetros Hemodinâmicos Obtidos por Ecocardiografia Transtorácica e Cateterismo da Artéria Pulmonar. Estudo Comparativo em Doentes Submetidos a Transplante Hepático
Objectivo: estudo comparativo simultâneo de medições invasivas utilizando o cateterismo da artéria pulmonar e não invasivas utilizando a ecocardiografia transtorácica (ETT) de 4 parâmetros hemodinâmicos: débito cardíaco (DC), pressão de encravamento da artéria pulmonar (PCP), pressão venosa central (PVC), e pressão sistólica da artéria pulmonar (PSAP).
Material e Métodos: estudo prospectivo numa Unidade de Cuidados Intensivos (UCI)
médico-cirurgica. Foram estudados 41 doentes em pós-operatório de transplante hepático, nos quais o DC, a PCP, a PVC e a PSAP foram obtidos em simultâneo por 2 observadores independentes, utilizando a ETT e o cateterismo invasivo da artéria pulmonar. Para a quantificação por ETT dos parâmetros foram utilizadas fórmulas descritas na literatura. As medições invasivas e não invasivas foram comparadas através de uma análise de correlação linear e de Bland-Altman.
Resultados: Verificou-se uma boa correlação nas medições invasivas e não invasivas
do DC (r=0,97) e PVC (r=0,88). As correlações entre as medições invasivas e não
invasivas da PCP e da PSAP foram fracas (r=0,41 e r= 0,118 respectivamente). O intervalo de confiança de 95% e bias para o DC foi negligenciável, em especial para valores de DC abaixo dos 6l/minuto. A ETT subestima em regra o DC, mas as duas técnicas
mostraram uma correlação significativa entre si.
Conclusões: a ETT pode estimar de forma fidedigna o DC em doentes submetidos a
transplante hepático. A determinação não invasiva das restantes variáveis
hemodinâmicas por ETT pode estar sujeita a uma variabilidade grande relacionada
com as características dos doentes. Apesar dos dados terem sido obtidos num grupo
específico de doentes, podem ajudar a definir uma aplicação futura da ecocardiografia em Cuidados Intensivos
Endobronchial Ultrasound under Moderate Sedation versus General Anesthesia
BACKGROUND:
Different anesthetic protocols may influence endobronchial ultrasound-guided needle aspiration (EBUS-TBNA) outcomes, patient comfort, and even safety. In this study, two anesthesia techniques were assessed and compared for EBUS-TBNA.
METHODS:
A prospective, multicenter study was carried out. Patients were allocated to Group 1 (general anesthesia with neuromuscular blockade and controlled ventilation) and Group 2 (intravenous sedation). EBUS-TBNA accuracy was the primary outcome. Safety, patient comfort and satisfaction, and operators' difficulties were defined as secondary outcomes.
RESULTS:
Of the 115 patients enrolled (Group 1 = 59, Group 2 = 56), EBUS-TBNA was performed for hilar or mediastinal lesion diagnosis and lung cancer staging in, respectively, 77 (67%) and 38 (33%) patients. The numbers of lymph nodes stations (1.8 ± 1.0 vs. 1.7 ± 1.0, p = 0.472) and punctures per station (6.9 ± 3.1 vs. 6.0 ± 2.5, p = 0.084) were similar between groups. Adequate samples were obtained from 109 patients (97.3%) with similar diagnostic accuracy. Procedure duration was not significantly different (p = 0.348). Hemodynamic parameters and systolic and diastolic blood pressures were higher in Group 1 at the beginning and at the end of the procedure. Adverse events were equally distributed, and no significant differences were found regarding patient satisfaction and bronchoscopist/anesthesiologist difficulties.
CONCLUSIONS:
The type of anesthesia used did not influence EBUS-TBNA outcomes. EBUS-TBNA performed under sedation or general anesthesia did not affect the diagnostic yield, complication rate, and patients' comfort and satisfaction.info:eu-repo/semantics/publishedVersio
H-Ferritin Is Essential for Macrophages' Capacity to Store or Detoxify Exogenously Added Iron
Macrophages are central cells both in the immune response and in iron homeostasis. Iron is both essential and potentially toxic. Therefore, iron acquisition, transport, storage, and release are tightly regulated, by several important proteins. Cytosolic ferritin is an iron storage protein composed of 24 subunits of either the L- or the H-type chains. H-ferritin differs from L-ferritin in the capacity to oxidize Fe2+ to Fe3+. In this work, we investigated the role played by H-ferritin in the macrophages' ability to respond to immune stimuli and to deal with exogenously added iron. We used mice with a conditional deletion of the H-ferritin gene in the myeloid lineage to obtain bone marrow-derived macrophages. These macrophages had normal viability and gene expression under basal culture conditions. However, when treated with interferon-gamma and lipopolysaccharide they had a lower activation of Nitric Oxide Synthase 2. Furthermore, H-ferritin-deficient macrophages had a higher sensitivity to iron-induced toxicity. This sensitivity was associated with a lower intracellular iron accumulation but a higher production of reactive oxygen species. These data indicate that H-ferritin modulates macrophage response to immune stimuli and that it plays an essential role in protection against iron-induced oxidative stress and cell death.Tis work was fnanced by FEDER - Fundo Europeu de Desenvolvimento Regional funds through the COMPETE2020 - Operacional Programme for Competitiveness and Internationalization (POCI), Portugal 2020, and by Portuguese funds through FCT - Fundação para a Ciência e a Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior in the framework of the project PTDC/IMI-MIC/1683/2014 (POCI-01-0145-FEDER-016590).
PFO and MGA acknowledge FCT for the Investigador FCT 2015. We thank the valuable collaboration of
the following i3S Scientifc Platforms: Cell Culture and Genotyping Core Facility (CCGen), [Histology and
Electron Microscopy Service (HEMS), and BioSciences Screening], member of the PPBI (PPBI-POCI-01-0145-FEDER-022122)], Animal Facility, and Flow Cytometry Unit (TraCy). We acknowledge Lukas Kuhn (Swiss Institute for Experimental Cancer Research, Lausanne, Switzerland) for kindly providing the frst breeding pairs of Fth1−/− mice. Te authors also acknowledge Marisa Castro, from Departamento de Biologia Molecular from ICBAS, Clara Bento, from i3S, and Edgar Pinto from LAQV – REQUIMTE for technical assistance at diferent stages of the project
Sequential sampling of Bemisia tuberculata (Bondar, 1923) (Hemiptera: Aleyrodidae) on cassava crop
VVV-WIT-04: An extragalactic variable source caught by the VVV Survey
We report the discovery of VVV-WIT-04, a near-infrared variable source
towards the Galactic disk located ~0.2 arcsec apart from the position of the
radio source PMN J1515-5559. The object was found serendipitously in the
near-IR data of the ESO public survey VISTA Variables in the V\'ia L\'actea
(VVV). Our analysis is based on variability, multicolor, and proper motion data
from VVV and VVV eXtended surveys, complemented with archive data at longer
wavelengths. We suggest that VVV-WIT-04 has an extragalactic origin as the
near-IR counterpart of PMN J1515-5559. The Ks-band light-curve of VVV-WIT-04 is
highly variable and consistent with that of an Optically Violent Variable (OVV)
quasar. The variability in the near-IR can be interpreted as the redshifted
optical variability. Residuals to the proper motion varies with the magnitude
suggesting contamination by a blended source. Alternative scenarios, including
a transient event such as a nova or supernova, or even a binary microlensing
event are not in agreement with the available data.R.K.S. acknowledges support from CNPq/Brazil through
projects 308968/2016-6 and 421687/2016-9. P.W.L. is supported by STFC Consolidated Grant ST/R000905/1. Support for the authors is provided by the BASAL CONICYT Center for Astrophysics and Associated Technologies
(CATA) through grant AFB-170002, and the Ministry for
the Economy, Development, and Tourism, Programa Iniciativa Cient´ıfica Milenio through grant IC120009, awarded to
the Millennium Institute of Astrophysics (MAS). D.M. acknowledges support from FONDECYT through project Regular #1170121
An Improved and Homogeneous Altimeter Sea Level Record from the ESA Climate Change Initiative
Sea Level is a very sensitive index of climate change since it integrates the impacts of ocean warming and ice mass loss from glaciers and the ice sheets. Sea Level has been listed as an Essential Climate Variable (ECV) by the Global Climate Observing System (GCOS). During the past 25 years, the sea level ECV has been measured from space by different altimetry missions that have provided global and regional observations of sea level variations. As part of the Climate Change Initiative (CCI) program of the European Space Agency (ESA) (established in 2010), the Sea Level project (SL_cci) aimed at providing an accurate and homogeneous long-term satellite-based sea level record. At the end of the first phase of the project (2010-2013), an initial version (v1.1) of the sea level ECV has been made available to users (Ablain et al., 2015).
During the second phase (2014-2017), improved altimeter standards have been selected to produce new sea level products (called SL_cci v2.0) based on 9 altimeter missions for the period 1993-2015 (https://doi.org/10.5270/esa-sea_level_cci-1993_2015-v_2.0-201612). Corresponding orbit solutions, geophysical corrections and altimeter standards used in this v2.0 dataset are described in details in Quartly et al. (2017). The present paper focuses on the description of the SL_cci v2.0 ECV and associated uncertainty and discusses how it has been validated. Various approaches have been used for the quality assessment such as internal validation, comparisons with sea level records from other groups and with in-situ measurements, sea level budget closure analyses and comparisons with model outputs. Compared to the previous version of the sea level ECV, we show that use of improved geophysical corrections, careful bias reduction between missions and inclusion of new altimeter missions lead to improved sea level products with reduced uncertainties at different spatial and temporal scales. However, there is still room for improvement since the uncertainties remain larger than the GCOS requirements. Perspectives for subsequent evolutions are also discussed
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