Avaliação dos efeitos da transfusão de sanguínea na saturação venosa mista e nos níveis de lactato em pacientes com SIRS/sepse

PURPOSE: To evaluate the effects of red blood cell transfusion in patients with SIRS/sepsis who presented hemoglobin levels under 9.0 g/dL at intensive care unit admission, using two parameters of organ perfusion: mixed venous oxygen saturation and serum lactate levels. METHODS: All patients admitted to the intensive care unit with SIRS/sepsis, as defined by Consensus Conference in 1992, and hemoglobin levels under 9.0 g/dL were included. Hemoglobin levels, mixed venous oxygen saturation, and lactate levels were collected before red blood cell transfusion (pre-T) and up to 1 hour after transfusion (post-T). These variables were analyzed through a paired t test, and results were considered significant if P < .05. RESULTS: Twenty-nine patients (17 male, 12 female) with ages of 61.9 ± 15.1 (mean ± SD) years (range, 21-85 years) and a mean APACHE II score of 12.5 ± 3.75 (7-21) were transfused with a mean of 1.41 packed red cell units. A significant increase in hemoglobin levels was reached by blood transfusion, from 8.14 ± 0.64 g/dL (pre-T) to 9.4 ± 0.33 g/dL (post-T), with POBJETIVOS: Avaliar o efeito da transfusão de hemáceas em pacientes com SIRS/sepse que apresentaram níveis de hemoglobina abaixo de 9,0g/dL durante internação em unidade de terapia intensiva, usando dois parâmetros de perfusão orgânica, a saturação venosa mista de oxigênio e os níveis de lactato sérico. MÉTODOS: Todos os pacientes admitidos na Unidade de Terapia Intensiva com SIRS/sepse, como definido pela Conferência de Consenso de 1992, e níveis de hemoglobina abaixo de 9,0g/dL foram incluídos. Os níveis de hemoglobina, saturação venosa mista de oxigênio e lactato sérico foram coletados antes (pré-T) e após uma hora da transfusão de hemáceas (pós-T). Essas variáveis foram analisadas através do teste T de Student pareado e os resultados considerados significativos se

Syphilis as osteomyelitis of the fifth metatarsal of the left foot: the great imitator hits once again

We report an unusual case of osteomyelitis of the left foot due to syphilitic bone involvement

Hypokalemia during the early phase of refeeding in patients with cancer

OBJECTIVE: Refeeding syndrome occurs in patients with severe malnutrition when refeeding begins after a long period of starvation. This syndrome increases the risk of clinical complications and mortality. Hypophosphatemia is considered the primary characteristic of the syndrome. The aim of our study was to investigate the presence of other electrolyte alterations in patients with cancer during the early stage of refeeding. METHODS: In this observational study, we enrolled 34 patients with cancer of the upper aerodigestive tract receiving upfront radiotherapy who were also enrolled in a nutrition program. A caloric intake assessment, anthropometric measurements and biochemical laboratory tests were performed. RESULTS: Significant weight loss (∼20%) was found in these patients. In the patients receiving artificial nutrition, we found lower levels of potassium and total protein compared with those who were fed orally (p = 0.03 for potassium and 0.02 for protein, respectively). Patients on enteral tube feeding had a higher caloric intake compared with those who were fed orally (25±5 kcal/kg/day vs. 10±2 kcal/kg/day). CONCLUSION: Hypokalemia, like hypophosphatemia, could be a complication associated with refeeding in patients with cancer. Hypokalemia was present in the early stages of high-calorie refeeding

La aplicación del consentimiento previo, libre e informado de los Pueblos Indígenas en la jurisprudencia del Tribunal Constitucional Peruano, 2022

En el presente trabajo de investigación se tuvo como objetivo determinar de qué manera el Consentimiento Previo, Libre e Informado en la jurisprudencia del Tribunal Constitucional Peruano resulta ser restrictiva respecto a los derechos fundamentales de los pueblos indígenas en Perú, en 2022, el cual responde a la pregunta ¿De qué forma el Consentimiento Previo, Libre e Informado en la jurisprudencia del Tribunal Constitucional Peruano resulta ser restrictiva respecto a los derechos fundamentales de los pueblos indígenas, Perú, 2022?. La metodología fue de tipo básica, con un enfoque cualitativo, de tipo descriptivo, con un diseño basado en teoría fundamentada, utilizando como instrumento la entrevista y como participantes a 12 expertos especializados en materia de derechos humanos, pueblos indígenas y derecho constitucional. Concluyendo que, el Tribunal Constitucional Peruano a través de su jurisprudencia ha desarrollado una línea argumentativa que imposibilita el reconocimiento como derecho al consentimiento previo, libre e informado, así también, en nuestro país el derecho fundamental a la consulta previa resulta insuficiente para resguardar los derechos colectivos e individuales de los pueblos indígenas, tales como a la libre determinación y a sus territorios