Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients

Submitted by Fábio Marques ([email protected]) on 2018-11-22T17:00:57Z No. of bitstreams: 1 Sepsis is a major determinant of outcome in HIV_Beatriz_Grinsztejn_INI_Lapclin-AIDS_2010.pdf: 326444 bytes, checksum: 176fa7e5a33453c31a87f95cfc16a782 (MD5)Approved for entry into archive by Regina Costa ([email protected]) on 2018-11-22T18:05:13Z (GMT) No. of bitstreams: 1 Sepsis is a major determinant of outcome in HIV_Beatriz_Grinsztejn_INI_Lapclin-AIDS_2010.pdf: 326444 bytes, checksum: 176fa7e5a33453c31a87f95cfc16a782 (MD5)Made available in DSpace on 2018-11-22T18:05:13Z (GMT). No. of bitstreams: 1 Sepsis is a major determinant of outcome in HIV_Beatriz_Grinsztejn_INI_Lapclin-AIDS_2010.pdf: 326444 bytes, checksum: 176fa7e5a33453c31a87f95cfc16a782 (MD5) Previous issue date: 2010Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.New challenges have arisen for the management of critically ill HIV/AIDS patients. Severe sepsis has emerged as a common cause of intensive care unit (ICU) admission for those living with HIV/AIDS. Contrastingly, HIV/AIDS patients have been systematically excluded from sepsis studies, limiting the understanding of the impact of sepsis in this population. We prospectively followed up critically ill HIV/AIDS patients to evaluate the main risk factors for hospital mortality and the impact of severe sepsis on the short- and long-term survival

Fenologia de quatro espécies arbóreas da Caatinga no Semiárido paraibano

The point of this paper was suppling necessary information to future of botany and ecology studies, in which it concerns the behavior of arboreal species. For so much, ten individuals of each one of the chosen species: “angico” (Anade- nanthera colubrina (Vell.) Brenan) – Fabaceae-Mimosoideae; “aroeira” (Myracrodruon urundeuva Allemão) – Anacardiaceae; “cumaru” (Amburana cearensis (Allemão) A.C. Smith) – Fabaceae e “oiticica” (Licania rigida Benth) – Chrysobalanaceae, were marked and numbered sequentially in an area of Caatinga located in Pombal’s region, Paraíba. Biweekly were made evaluations for the identification of the spring up phenophases, leaf formation, flowering, fructification and seeds dispersion. The Anadenanthera colubrina, M. urundeuva Amburana carens and are classified as deciduous species, with leaf abscission between September and December (dry season) and regrowth between January and August (rainy season) in the semiarid re- gion of Paraíba, while the Licania rigida is classified as a perennial species, not to present the phenomenon of leaf abscission during the evaluation period. All species have their diaspores dispersed even in the dry season. The species Anadenanthera colubrina has different peaks in phenological phases of flowering throughout the year, with fruiting and seed dispersal occur- ring in the rainy and dry season of the region. The phenology of four species aredistinguished according to the temporal distri- bution of weather events.Objetivou-se caracterizar a fenologia de quarto espécies arbóreas de ocorrência em área de caatinga na região do Semiárido paraibano. Para tanto, dez indivíduos de cada uma das espécies escolhidas: angico (Anadenanthera colubrina (Vell.) Brenan) – Fabaceae-Mimosoideae; aroeira (Myracrodruon urundeuva Allemão) – Anacardiaceae; cumaru (Amburana cearen- sis (Allemão) A.C. Smith) – Fabaceae e oiticica (Licania rigida Benth) – Chrysobalanaceae, foram marcados e numerados sequencialmente em uma área de caatinga situada na região de Pombal - PB. Quinzenalmente foram realizadas avaliações para a identificação das fenofases de brotamento, floração, frutificação e dispersão de diásporos ou sementes. As espécies Anade- nanthera colubrina, Myracrodruon urundeuva e Amburana carensis são classificadas como espécies decíduas, apresentando abscisão das folhas entre setembro e dezembro (estação seca) e a rebrota entre janeiro e agosto (estação chuvosa) na região do semiárido paraibano, enquanto a Licania rigida é classificada como uma espécie perene, por não apresentar o fenômeno de abscisão foliar ao longo do período de avaliação. Todas as espécies estudadas apresentam dispersão de seus diásporos ainda na estação seca. A espécie Anadenanthera colubrina apresenta diferentes picos nas fenofases de floração ao longo do ano, com frutificação e dispersão de sementes ocorrendo parte na estação chuvosa e parte na estação seca da região. Os padrões fenoló- gicos das quatro espécies estudadas são distinguidos de acordo com a distribuição temporal dos eventos climáticos

Estrutura do componente arbustivo/arbóreo de uma área de caatinga situada no município de Pombal, PB

The degradation of the Caatinga by the antropic action it compromises each time more the natural resources and the support of bioma. In this way, aiming at to increase the knowledge about the vegetation, it was objectified to carry through a phyto-sociologic survey in a situated area of caatinga, in Pombal - PB. For sampling of the arbustive/arboreal component had been launched 25 parcels of 400m2 of systematic way with spacement of 10 m. The individuals with circumference had been showed to the height of the chest (CAP) ≥ 6 cm. Later it was made the calculus for the phyto-sociologic parameters, diametric distribution and floristic similarity between the parcels. Analyzing the points, were gotten 2.756 pertaining individuals to 23 taxons and 14 families, which one 1,860 belonged to the same species. The index of diversity of the area is about 1.33 nats/ind-1. The basal area calculated was about 11.546 m2 .ha-1 . Croton sonderianus was the species that presented the biggest value of importance.A degradação da Caatinga por meio da ação antrópica acaba por comprometer cada vez mais os recursos naturais e a sustentabilidade do bioma. Deste modo, visando acrescer o conhecimento sobre a vegetação, objetivou-se realizar um levantamento fitossociológico em uma área de caatinga situada, no município de Pombal - PB. Para amostragem do componente arbustivo/arbóreo foram lançadas 25 parcelas de 400 m2 de forma sistemática com espaçamento de 10 m. Foram amostrados todos os indivíduos com circunferência altura do peito (CAP) ≥ 6 cm. Posteriormente fez-se os cálculos para os parâmetros fitossociológicos, distribuição diamétrica e similaridade florística entre as parcelas. Analisando os dados, obteve-se 2.756 indivíduos pertencentes a 23 táxons e 14 famílias dos quais 1.860 pertencia à mesma espécie. O índice de diversidade da área é de 1,33 nats/ind-1. A área basal calculada foi de 11,546 m2 .ha-1 . Croton sonderianus foi à espécie que apresentou o maior valor de importância.La degradación del Caatinga por medio de la acción del antrópica acaba por comprometer cada vez más los recursos naturales y la sustentabilidad del bioma. Así, teniendo como objetivo aumentar el conocimiento en la vegetación, he sido objetivado realizar un levantamiento fitossociológico en un área situada del caatinga, en la ciudad de Pombal - PB. Como amostragen del componente arbustivo/arbóreo había sido puesto 25 paquetas de 400m2 de la forma sistemática con el espassamento de 10m. Habían demostrado todos los individuos con circunferencia a la altura del pecho ≥ (CAP) 6 cm. En más adelante se convirtió los cálculos a los parámetros fitossociológicos, de la distribución diamétrica y de la semejanza del florística entre los paquetes. Analizando los datos, consiguieron 2.756 individuos que pertenecían a 23 táxons y 14 familias, cuyo 1.860 pertenecieron a la misma especie. El índice de la diversidad del área está de 1.33 nats/ind-1. La zona basimétrica calculada estaba de 11.546 m2 .ha-1. El Croton sonderianus era la especie que presentó el valor más grande de importancia

A central role for free heme in the pathogenesis of severe sepsis.

Low-grade polymicrobial infection induced by cecal ligation and puncture is lethal in heme oxygenase-1-deficient mice (Hmox1(-/-)), but not in wild-type (Hmox1(+/+)) mice. Here we demonstrate that the protective effect of this heme-catabolizing enzyme relies on its ability to prevent tissue damage caused by the circulating free heme released from hemoglobin during infection. Heme administration after low-grade infection in mice promoted tissue damage and severe sepsis. Free heme contributed to the pathogenesis of severe sepsis irrespective of pathogen load, revealing that it compromised host tolerance to infection. Development of lethal forms of severe sepsis after high-grade infection was associated with reduced serum concentrations of the heme sequestering protein hemopexin (HPX), whereas HPX administration after high-grade infection prevented tissue damage and lethality. Finally, the lethal outcome of septic shock in patients was also associated with reduced HPX serum concentrations. We propose that targeting free heme by HPX might be used therapeutically to treat severe sepsis

Role of organisational factors on the 'weekend effect' in critically ill patients in Brazil: a retrospective cohort analysis

Submitted by Janaína Nascimento ([email protected]) on 2019-02-07T11:22:51Z No. of bitstreams: 1 ve_Zampieri_Fernando_etal_INI_2018.pdf: 1857014 bytes, checksum: 3f16399e2c8e4351d5d911156f29da22 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-02-12T12:12:17Z (GMT) No. of bitstreams: 1 ve_Zampieri_Fernando_etal_INI_2018.pdf: 1857014 bytes, checksum: 3f16399e2c8e4351d5d911156f29da22 (MD5)Made available in DSpace on 2019-02-12T12:12:17Z (GMT). No. of bitstreams: 1 ve_Zampieri_Fernando_etal_INI_2018.pdf: 1857014 bytes, checksum: 3f16399e2c8e4351d5d911156f29da22 (MD5) Previous issue date: 2018Hospital do Coração. Instituto de Pesquisa. São Paulo, SP, Brasil / Hospital Alemão Oswaldo Cruz. São Paulo, SP, Brasil.Santa Casa de Misericórdia de Porto Alegre. Complexo Hospitalar. Unidade de Cuidados Intensivos. Porto Alegre, RS, Brasil.Hospital Israelita Albert Einstein. São Paulo, SP, Brasil.D’Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Hospital São Francisco. Ribeirão Preto, SP, Brasil.Hospital São Luiz Brasil. Santo André, SP, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Rede Amil de Hospitais. Unidade de Cuidados Intensivos. Rio de Janeiro, RJ, Brasil.Hospital Barra D’Or. Rio de Janeiro, RJ, Brasil.Hospital São Luís. São Luís, MA, Brasil.Hospital São Lucas. Rio de Janeiro, RJ, Brasil.Hospital São Luiz. São Paulo, SP, Brazil / Hospital Samaritano. São Paulo, SP, Brasil.Hospital Alemão Oswaldo Cruz. São Paulo, SP, Brasil.Hospital Sírio-Libanês. São Paulo, SP, Brasil.Hospital Copa D’Or. Rio de Janeiro, RJ, Brasil.Hospital Quinta D’Or. Rio de Janeiro, RJ, Brasil.Hospital Esperança Olinda. Olinda, PE, Brasil.Hospital Santa Luzia. Brasília, DF, Brasil.Hospital Unimed Vitória. Vitória, ES, Brasil.D’Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil.D’Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil.Introduction: Higher mortality for patients admitted to intensive care units (ICUs) during the weekends has been occasionally reported with conflicting results that could be related to organisational factors. We investigated the effects of ICU organisational and staffing patterns on the potential association between weekend admission and outcomes in critically ill patients. Methods: We included 59 614 patients admitted to 78 ICUs participating during 2013. We defined ‘weekend admission’ as any ICU admission from Friday 19:00 until Monday 07:00. We assessed the association between weekend admission with hospital mortality using a mixed logistic regression model controlling for both patientlevel (illness severity, age, comorbidities, performance status and admission type) and ICU-level (decrease in nurse/bed ratio on weekend, full-time intensivist coverage, use of checklists on weekends and number of institutional protocols) confounders. We performed secondary analyses in the subgroup of scheduled surgical admissions. Results: A total of 41 894 patients (70.3%) were admitted on weekdays and 17 720 patients (29.7%) on weekends. In univariable analysis, weekend admitted patients had higher ICU (10.9% vs 9.0%, P<0.001) and hospital (16.5% vs 13.5%, P<0.001) mortality. After adjusting for confounders, weekend admission was not associated with higher hospital mortality (OR 1.05, 95%CI 0.99 to 1.12, P=0.095). However, a ‘weekend effect’ was still observed in scheduled surgical admissions, as well as in ICUs not using checklists during the weekends. For unscheduled admissions, no ‘weekend effect’ was observed regardless of ICU’s characteristics. For scheduled surgical admissions, a ‘weekend effect’ was present only in ICUs with a low number of implemented protocols and those with a reduction in the nurse/bed ratio and not applying checklists during weekends. Conclusions: ICU organisational factors, such as decreased nurse-to-patient ratio, absence of checklists and fewer standardised protocols, may explain, in part, increases in mortality in patients admitted to the ICU mortality on weekends

In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil.

BackgroundWe evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort.MethodsThis prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan-Meier curves and Cox proportional-hazard models were performed.Findings1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9-32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8-29.2)] died during hospitalization (median time 14 (IQR,9-24) days). Older age [vs&lt;40 years; age=60-69 years-aHR=1.89 (95%CI,1.08-3.32); age=70-79 years-aHR=2.52 (95%CI,1.42-4.45); age≥80-aHR=2.90 (95%CI 1.54-5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30-2.19)]; SAPS-III score≥57 [vs&lt;57; aHR=1.47 (95%CI 1.13-1.92)] and SOFA score≥10 [vs &lt;10; aHR=1.51 (95%CI 1.08-2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3-8.4)] had a rehospitalization or death [rate=323 (95%CI 250-417) per 1000 person-years] in a median time of 52 (range 1-280) days post-hospital discharge. Age ≥ 60 years [vs &lt;60, aHR=2.13 (95%CI 1.15-3.94)] and SAPS-III ≥57 at admission [vs &lt;57, aHR=2.37 (95%CI 1.22-4.59)] were independently associated with rehospitalization or death after hospital discharge.InterpretationHigh in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge.FundingFundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ