The validity and reliability of the Portuguese versions of three tools used to diagnose delirium in critically ill patients

OBJECTIVES: The objectives of this study are to compare the sensitivity and specificity of three diagnostic tools for delirium (the Intensive Care Delirium Screening Checklist, the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet) in a mixed population of critically ill patients, and to validate the Brazilian Portuguese Confusion Assessment Method for Intensive Care Units. METHODS: The study was conducted in four intensive care units in Brazil. Patients were screened for delirium by a psychiatrist or neurologist using the Diagnostic and Statistical Manual of Mental Disorders. Patients were subsequently screened by an intensivist using Portuguese translations of the three tools. RESULTS: One hundred and nineteen patients were evaluated and 38.6% were diagnosed with delirium by the reference rater. The Confusion Assessment Method for Intensive Care Units had a sensitivity of 72.5% and a specificity of 96.2%; the Confusion Assessment Method for Intensive Care Units Flowsheet had a sensitivity of 72.5% and a specificity of 96.2%; the Intensive Care Delirium Screening Checklist had a sensitivity of 96.0% and a specificity of 72.4%. There was strong agreement between the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet (kappa coefficient = 0.96) CONCLUSION: All three instruments are effective diagnostic tools in critically ill intensive care unit patients. In addition, the Brazilian Portuguese version of the Confusion Assessment Method for Intensive Care Units is a valid and reliable instrument for the assessment of delirium among critically ill patients

ENCEFALITE POR ENTEROVÍRUS EM UMA PACIENTE ADULTA IMUNOCOMPETENTE

Mulher, 45 anos, previamente hígida, foi internada por quadro de confusão mental, agitação psicomotora e crises epilépticas iniciado 3 dias após receber vacina tríplice viral. Hipótese diagnóstica inicial foi de encefalite pós-vacinal, ácido valproico 1500 mg/dia foi introduzido para controle das crises. Devido a possibilidade de encefalite herpética, fez uso de aciclovir venoso. Durante a internação realizou ressonância magnética (RM) de crânio que evidenciou lesões hiperintensas em FLAIR nos centros semiovais e lobo temporal direito. Líquor com 01 célula (100% mono), glicose (78mg/dl), proteínas (38mg/dl), teste de reação em cadeia da polimerase (PCR) para HSV1, HSV2, VZV, EBV, CMV, HH6, HH8 e sarampo negativos; PCR para enterovírus (EV) detectável, confirmando diagnóstico de encefalite por EV. Após melhora do quadro neurológico e sem novos episódios de crises epilépticas, recebeu alta hospitalar para seguimento pela neurologia. Durante acompanhamento precisou da conciliação das doses das drogas anticrise (DAC) sendo o último esquema em uso composto por ácido valproico 1500mg/dia e fenitoína 300mg/dia. Após três anos de acompanhamento ambulatorial, foi diagnosticada com tuberculose ganglionar confirmada por GeneXpert MTB-RIF detectável, sensível à rifampicina em material de biópsia de linfonodo. Nova sorologia para HIV não reagente. Iniciou RHZE, foi realizada troca de fenitoína por levetiracetam por interação medicamentosa com isoniazida. Um mês após o início do RHZE, reinternou por novo quadro de crise epiléptica, após ampla investigação, excluído nova infecção e aventada hipótese de crise epiléptica secundaria a uso de isoniazida, não sendo necessário sua interrupção, apenas ajuste das DAC, para melhora do quadro. A incidência de encefalite em adultos varia de 0,7-12,6/100.000 habitantes, sendo maior em crianças menores de um ano. A encefalite viral é a causa mais comum de encefalite e as etiologias mais comuns em todo o mundo são: herpes vírus (HSV-1/HSV-2), arbovírus e enterovírus não poliomielite. Os enterovírus (EV) possuem mais de 70 sorotipos; o sorotipo EV-71 tem sido associado a uma taxa mais alta de encefalite. O diagnóstico é realizado por identificação do EV por PCR. A RM cerebral pode evidenciar lesões hiperintensas de T2WI e FLAIR no mesencéfalo, ponte e medula. Cerca de 20% dos pacientes recuperados apresentam sequelas neurológicas. A isoniazida raramente (0,01%) pode causar sintomas neurológicos como crises epilépticas

Clinical characteristics of patients with cerebellar ataxia associated with anti-GAD antibodies

ABSTRACT The enzyme glutamic acid decarboxylase (GAD), present in GABAergic neurons and in pancreatic beta cells, catalyzes the conversion of gamma-aminobutyric acid (GABA). The cerebellum is highly susceptible to immune-mediated mechanisms, with the potentially treatable autoimmune cerebellar ataxia associated with the GAD antibody (CA-GAD-ab) being a rare, albeit increasingly detected condition. Few cases of CA-GAD-ab have been described. Methods This retrospective and descriptive study evaluated the clinical characteristics and outcomes of patients with CA-GAD-ab. Result Three patients with cerebellar ataxia, high GAD-ab titers and autoimmune endocrine disease were identified. Patients 1 and 2 had classic stiff person syndrome and insidious-onset cerebellar ataxia, while Patient 3 had pure cerebellar ataxia with subacute onset. Patients received intravenous immunoglobulin therapy with no response in Patients 1 and 3 and partial recovery in Patient 2. Conclusion CA-GAD-ab is rare and its clinical presentation may hamper diagnosis. Clinicians should be able to recognize this potentially treatable autoimmune cerebellar ataxia

Fungemia associated with Schizophyllum commune in Brazil

Submitted by ALBERTO LEMOS ([email protected]) on 2017-10-27T21:32:35Z No. of bitstreams: 1 Fungemia associated with Schizophyllum commune in Brazil.pdf: 1989327 bytes, checksum: bf00616626bdba2d7004c8512efb913d (MD5)Approved for entry into archive by Raphael Belchior Rodrigues ([email protected]) on 2017-11-27T10:59:17Z (GMT) No. of bitstreams: 1 Fungemia associated with Schizophyllum commune in Brazil.pdf: 1989327 bytes, checksum: bf00616626bdba2d7004c8512efb913d (MD5)Made available in DSpace on 2017-11-27T10:59:17Z (GMT). No. of bitstreams: 1 Fungemia associated with Schizophyllum commune in Brazil.pdf: 1989327 bytes, checksum: bf00616626bdba2d7004c8512efb913d (MD5) Previous issue date: 2017Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Micologia. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Programa de Residência Médica em Infectologia. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Micologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Centro de Clínicas. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Micologia. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Programa de Residência Médica em Infectologia. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Programa de Residência Médica em Infectologia. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Neuroinfecções. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Serviço de Imagem. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Dermatologia Infecciosa. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Micologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Micologia. Rio de Janeiro, RJ. Brasil

<i>Schizophyllum commune</i> infection in an HIV-infected patient.

<p><b>(A)</b> Brain CT scan showing contrast-enhancing lesions in both cerebral hemispheres associated with mass effect and a hypodense lesion in the right caudate nucleus suggestive of encephalomalacia from previous lesions. <b>(B)</b> <i>S</i>. <i>commune</i> 1083H colony on potato dextrose agar (PDA) agar after 14 days at 25°C; fruiting bodies are not present on the hyphae. <b>(C)</b> Slide culture of the <i>S</i>. <i>commune</i> isolate on PDA showing hyaline, septate hyphae with spicules and without clamp connections.</p

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data