Hypothermia in a surgical intensive care unit

BACKGROUND: Inadvertent hypothermia is not uncommon in the immediate postoperative period and it is associated with impairment and abnormalities in various organs and systems that can lead to adverse outcomes. The aim of this study was to estimate the prevalence, the predictive factors and outcome of core hypothermia on admission to a surgical ICU. METHODS: All consecutive 185 adult patients who underwent scheduled or emergency noncardiac surgery admitted to a surgical ICU between April and July 2004 were admitted to the study. Tympanic membrane core temperature (Tc) was measured before surgery, on arrival at ICU and every two hours until 6 hours after admission. The following variables were also recorded: age, sex, body weight and height, ASA physical status, type of surgery, magnitude of surgical procedure, anesthesia technique, amount of intravenous fluids administered during anesthesia, use of temperature monitoring and warming techniques, duration of the anesthesia, ICU length of stay, hospital length of stay and SAPS II score. Patients were classified as either hypothermic (Tc ≤ 35°C) or normothermic (Tc> 35°C). Univariate analysis and multiple regression binary logistic with an odds ratio (OR) and its 95% Confidence Interval (95%CI) were used to compare the two groups of patients and assess the relationship between each clinical predictor and hypothermia. Outcome measured as ICU length of stay and mortality was also assessed. RESULTS: Prevalence of hypothermia on ICU admission was 57.8%. In univariate analysis temperature monitoring, use of warming techniques and higher previous body temperature were significant protective factors against core hypothermia. In this analysis independent predictors of hypothermia on admission to ICU were: magnitude of surgery, use of general anesthesia or combined epidural and general anesthesia, total intravenous crystalloids administrated and total packed erythrocytes administrated, anesthesia longer than 3 hours and SAPS II scores. In multiple logistic regression analysis significant predictors of hypothermia on admission to the ICU were magnitude of surgery (OR 3.9, 95% CI, 1.4–10.6, p = 0.008 for major surgery; OR 3.6, 95% CI, 1.5–9.0, p = 0.005 for medium surgery), intravenous administration of crystalloids (in litres) (OR 1.4, 95% CI, 1.1–1.7, p = 0.012) and SAPS score (OR 1.0, 95% CI 1.0–1.7, p = 0.014); higher previous temperature in ward was a significant protective factor (OR 0.3, 95% CI 0.1–0.7, p = 0.003). Hypothermia was neither a risk factor for hospital mortality nor a predictive factor for staying longer in ICU. CONCLUSION: The prevalence of patient hypothermia on ICU arrival was high. Hypothermia at time of admission to the ICU was not an independent factor for mortality or for staying longer in ICU

Renal replacement therapy in Europe: a summary of the 2012 ERA-EDTA Registry Annual Report

BACKGROUND: This article summarizes the 2012 European Renal Association-European Dialysis and Transplant Association Registry Annual Report (available at www.era-edta-reg.org) with a specific focus on older patients (defined as ≥65 years). METHODS: Data provided by 45 national or regional renal registries in 30 countries in Europe and bordering the Mediterranean Sea were used. Individual patient level data were received from 31 renal registries, whereas 14 renal registries contributed data in an aggregated form. The incidence, prevalence and survival probabilities of patients with end-stage renal disease (ESRD) receiving renal replacement therapy (RRT) and renal transplantation rates for 2012 are presented. RESULTS: In 2012, the overall unadjusted incidence rate of patients with ESRD receiving RRT was 109.6 per million population (pmp) (n = 69 035), ranging from 219.9 pmp in Portugal to 24.2 pmp in Montenegro. The proportion of incident patients ≥75 years varied from 15 to 44% between countries. The overall unadjusted prevalence on 31 December 2012 was 716.7 pmp (n = 451 270), ranging from 1670.2 pmp in Portugal to 146.7 pmp in the Ukraine. The proportion of prevalent patients ≥75 years varied from 11 to 32% between countries. The overall renal transplantation rate in 2012 was 28.3 pmp (n = 15 673), with the highest rate seen in the Spanish region of Catalonia. The proportion of patients ≥65 years receiving a transplant ranged from 0 to 35%. Five-year adjusted survival for all RRT patients was 59.7% (95% confidence interval, CI: 59.3-60.0) which fell to 39.3% (95% CI: 38.7-39.9) in patients 65-74 years and 21.3% (95% CI: 20.8-21.9) in patients ≥75 years

The complexity of social intervention according to gender and education of chronic kidney disease patients

A elevada prevalência da doença renal crónica e a relevância social do seu tratamento exigem um aprofundamento do conhecimento sobre a população doente, tendo em conta a sua complexidade holística. O estudo pretendeu analisar os níveis de complexidade no processo de intervenção social com pessoas com doença renal crónica numa perspetiva de gênero e de escolaridade. A amostra integrou 584 doentes com idades compreendidas entre os 19 e os 93 anos, maioritariamente do sexo masculino, casados e com o 1.º ciclo ensino básico. Os participantes, com diagnóstico de doença renal crónica, foram avaliados através de um protocolo que inclui um questionário sociodemográfico e a Matriz de Complexidade Associada ao Processo de Intervenção Social com Doentes Renais Crónicos (MCAPIS_DRC). Encontrou-se uma associação estatisticamente significativa entre os três níveis de complexidade avaliados e as variáveis sexo (p = 0,002, phi = 0,146) e escolaridade (p > 0,001, phi = 0,277). Verificou-se, igualmente, uma interação entre a escolaridade e o índice de complexidade consoante o sexo (F(5, 572) = 6,647 p = < 0,001, ƞp2 = 0,113). As mulheres apresentaram maiores pontuações no índice e as pessoas com maiores níveis de escolaridade pontuam menos no índice. A evidência permite ter uma abordagem diferenciadora na avaliação e intervenção social, priorizando grupos e situações problema

Feeding inhibition in Corbicula fluminea (OF Muller, 1774) as an effect criterion to pollutant exposure: perspectives for ecotoxicity screening and refinement of chemical control

Bivalves are commonly used in biomonitoring programs to track pollutants. Several features, including its filter feeding abilities, cumulatively argue in favour of the use of the Asian clam (Corbicula fluminea) as a biosentinel and an ecotoxicological model. Filtration in bivalves is very sensitive to external stimuli and its control is dictated by regulation of the opening/closure of the valves, which may be used as an avoidance defence against contaminants. Here, we investigate the filter-feeding behaviour of the Asian clam as an endpoint for assessing exposure to pollutants, driven by two complementary goals: (i) to generate relevant and sensitive toxicological information based on the ability of C. fluminea to clear an algal suspension, using the invasive species as a surrogate for native bivalves; (ii) to gain insight on the potential of exploring this integrative response in the refinement of chemical control methods for this pest. Clearance rates and proportion of algae removed were measured using a simple and reproducible protocol. Despite some variation across individuals and size classes, 50-90% of food particles were generally removed within 60-120 min by clams larger than 20 mm. Removal of algae was sensitive to an array of model contaminants with biocide potential, including fertilizers, pesticides, metals and salts: eight out of nine tested substances were detected at the mu g l(-1) or mg l(-1) range and triggered valve closure, decreasing filter-feeding in a concentration-dependent manner. For most toxicants, a good agreement between mortality (96 h - LC50 within the range 0.4-5500 mg l(-1)) and feeding (2 h - 1050 within the range 0.005-2317 mg l(-1)) was observed, demonstrating that a 120-min assay can be used as a protective surrogate of acute toxicity. However, copper sulphate was very strongly avoided by the clams (IC50 = 5.3 mu g l(-1)); on the contrary, dichlorvos (an organophosphate insecticide) did not cause feeding depression, either by being undetected by the clams' chemosensors and/or bThis work was supported by the strategic programs UID/AMB/50017/2013 (POCI-01-0145-FEDER-007638) and UID/BIA/04050/2013 (POCI-01-0145-FEDER-007569), funded by the European Regional Development Fund through COMPETE2020 and PT2020, and by National Funds through the Portuguese Science Foundation (FCT). Funding entities had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the paper, or in the decision to submit the article for publication. JL Pereira is a recipient of an individual research grant by FCT (SFRH/BPD/101971/2014).info:eu-repo/semantics/publishedVersio

The bad against the villain: suitability of Corbicula fluminea as a bioremediation agent towards cyanobacterial blooms

Cyanobacteria can cause ecological, economic and human health problems, climate change trends giving them advantage over other phytoplanktonic groups. Management strategies exist to deal with the nuisance, but many are not effective due to the likelihood of cell lysis and toxin release. This study explores the suitability of the use of the invasive and widespread bivalve Corbicula fluminea for cyanobacterial control. The capacity of clams to filter and ingest cyanobacteria was evaluated using a set of bloom-forming strains comprising different morphological features potentially affecting edibility and palatability. Results generally showed limited filtration of the majority of cyanobacteria, compared with green microalgae used as the reference for optimal filtration (ca. 60 μg Chl a removed in 120 min), except for Pseudanabaena (ca. 90 μg Chl a removed) and Anabaena (ca. 120 μg Chl a removed). The specific attention given to the binomial filtration-ingestion exposed that filtration often directly relates to the deposit of cyanobacteria as pseudofaeces rather than reflects assimilation through effective ingestion. Allocation to pseudofaeces accounted for more than 50% of the Chl a removed from water for all cyanobacteria tested. Adding to effective filtration by the clam, the related accumulation of cyanobacterial biomass in pseudofaeces has the potential for further exploitation since it can be functionally paralleled with the use of synthetic flocculants for cyanobacterial (villain) removal in settings where a natural treatment alternative using an (bad) invasive bivalve could be suitable yet controlled to avoid side ecosystem effectspublishe

Jellyfish in the Attic. On the Theory and Practice of the Creative Process

This study aimed to assess the social impact of COVID-19 on chronic kidney disease patients, a vulnerable population, by analysing the social problems that emerged and aggravated during the pandemic’s first phase. 117 CKD patients on treatment, referred to Social Work, participated in this study. New referrals were 37.6%, and 62.4% were aggravated situations, presenting mostly economic deprivation or lack of income, unemployment, and social isolation. The social intervention complexity was higher among those with aggravated social problems. The results allow social workers to plan interventions focused on the most relevant emerging issues in a pandemic challenging context.  Celem prezentowanego badania była ocena społecznego wpływu pandemii COVID-19 na pacjentów z przewlekłą chorobą nerek, populację szczególnie narażoną na liczne powikłania w przypadku zarażenia się wirusem SARS-CoV-2. Autorzy skupili się na analizie problemów społecznych, które pojawiły się i nasiliły w pierwszej fazie pandemii. W badaniu wzięło udział 117 pacjentów leczonych w CKD, skierowanych do otrzymania pomocy socjalnej. Zaobserwowano wzrost liczby osób kierowanych do otrzymania pomocy. Nowych zgłoszeń było 37,6%, a 62,4% z nich związane było z pogorszeniem społeczno-ekonomicznej sytuacji pacjenta – głównie deprywacją ekonomiczną lub brakiem dochodów, bezrobociem i izolacją społeczną. Złożoność interwencji socjalnej była wyższa wśród osób z nasilonymi problemami społecznymi. Wyniki otrzymanych badań mają nie tylko walor naukowy, lecz także praktyczny – pozwalają pracownikom socjalnym na planowanie pomocy skoncentrowanej na najistotniejszych problemach pojawiających się w kontekście wyzwań pandemicznych