Avaliação do tratamento com penicilina em pacientes com leptospirose e insuficiência renal aguda

The effectiveness of specific antibiotic treatment in severe leptospirosis is still under debate. As part of a prospective study designed to evaluate renal function recovery after leptospirosis acute renal failure (ARF) (ARF was defined as Pcr >; or = 1.5 mg/dL), the clinical evolutions of 16 treated patients (T) were compared to those of 18 untreated patients (nT). Treatment or non-treatment was the option of each patient's attending infectologist. The penicillin treatment was always with 6 million IU/day for 8 days. No difference was found between the two groups in terms of age, gender, number of days from onset of symptoms to hospital admission, or results of laboratory tests performed upon admission and during hospitalization, but proteinuria was higher in the treated group. There were no significant difference in the other parameters employed to evaluate patients' clinical evolution as: length of hospital stay, days of fever, days to normalization of renal function, days to total bilirubins normalized or reached 1/3 of maximum value and days to normalization of platelet counts. Dialytic treatment indication and mortality were similar between group T and nT. In conclusion, penicillin therapy did not provide better clinical outcome in patients with leptospirosis and ARF.A eficácia da antibioticoterapia no tratamento da leptospirose humana tem sido motivo de discussão. Como parte de um trabalho prospectivo para avaliar a recuperação da função renal após a insuficiência renal aguda (IRA) da leptospirose (IRA definida como Pcr >; ou = 1,5 mg/dL), comparou-se a evolução clínica durante a internação de 16 pacientes, com leptospirose grave, tratados (T) com 18 não tratados (nT). O tratamento com ou sem penicilina foi opção de cada infectologista responsável pelo paciente. Quando tratados, foi administrado penicilina 6 milhões de U/dia por 8 dias. Os parâmetros analisados como idade, sexo, tempo do início dos sintomas à admissão, exames laboratoriais da admissão e internação não foram significativamente diferentes nos dois grupos, exceto pela proteinúria que foi significativamente mais elevada no grupo T. A recuperação clínica da doença avaliada pelo tempo: de internação, de febre, para função renal e níveis de plaquetas normalizarem e para os níveis de bilirrubinas totais caírem a 1/3 do valor máximo ou normalizar não foram diferentes no grupo tratado e não tratado. A indicação do tratamento dialítico e a mortalidade também não foram diferentes nos dois grupos. Conclui-se que na leptospirose com IRA o tratamento com penicilina não mudou o curso da doença

Risk factors for death among critically ill elderly patients

OBJETIVO: A população idosa está aumentando em todo o mundo, assim como a necessidade de cuidados intensivos para os idosos. Existem poucos estudos que investiguem os fatores de risco para óbito em pacientes idosos gravemente enfermos. Este estudo teve o objetivo de investigar os fatores associados ao óbito em uma população de pacientes idosos gravemente enfermos admitidos a uma unidade de terapia intensiva no Brasil. MÉTODOS: Estudo retrospectivo de coorte que incluiu todos os pacientes idosos (idade &#8805; 60 anos) admitidos a uma unidade de terapia intensiva em Fortaleza, Brasil, de janeiro a dezembro de 2007. Foi realizada uma comparação entre os sobreviventes e os não sobreviventes, e os fatores de risco para óbito foram investigados por meio de análise univariada e multivariada. RESULTADOS: Foi incluído um total de 84 pacientes, com uma média de idade de 73 ± 7,6 anos, sendo 59% do gênero feminino. A mortalidade foi de 62,8%. A principal causa de morte foi disfunção de múltiplos órgãos (42,3%), seguido por choque séptico (36,5%) e choque cardiogênico (9,7%). As complicações durante a permanência na unidade de terapia intensiva associadas com óbito foram insuficiência respiratória (OR = 61; p<0.001), lesão renal aguda (OR =23, p<0,001), sepse (OR = 12; p<0,001), acidose metabólica (OR = 17; p<0,001), anemia (OR = 8,6; p<0,005), distúrbios da coagulação (OR = 5,9; p<0,001) e fibrilação atrial (OR = 4,8; P<0,041). Os fatores de risco independentes para óbito foram idade (OR = 1,15; p<0,005), coma (OR = 7,51; p<0,003), hipotensão (OR = 21,75; p=0,003), insuficiência respiratória (OR = 9,93; p<0,0001), e lesão renal aguda (OR = 16,28; p<0,014). CONCLUSÕES: A mortalidade é elevada em pacientes idosos gravemente enfermos. Os fatores associados ao óbito foram idade, coma, hipotensão, insuficiência respiratória e lesão renal aguda.BACKGROUND: The elderly population is increasing all over the world. The need of intensive care by the elderly is also increasing. There is a lack of studies investigating the risk factors for death among critically ill elderly patients. This study aims to investigate the factors associated with death in a population of critically ill elderly patients admitted to an intensive care unit in Brazil. METHODS: This is a retrospective cohort study including all elderly patients (&gt;60 years) admitted to an intensive care unit in Fortaleza, Brazil, from January to December 2007. A comparison between survivors and nonsurvivors was done and the risk factors for death were investigated through univariate and multivariate analysis. RESULTS: A total of 84 patients were included, with an average age of 73 ± 7.6 years; 59% were female. Mortality was 62.8%. The main cause of death was multiple organ dysfunction (42.3%), followed by septic shock (36.5%) and cardiogenic shock (9.7%). Complications during intensive care unit ICU stay associated with death were respiratory failure (OR=61, p<0.001), acute kidney injury (OR=23, p<0.001), sepsis (OR=12, p<0.001), metabolic acidosis (OR=17, p<0.001), anemia (OR=8.6, p<0.005), coagulation disturbance (OR=5.9, p<0.001) and atrial fibrillation (OR=4.8, p<0.041). Independent risk factors for death were age (OR=1.15, p<0.005), coma (OR=7.51, p<0.003), hypotension (OR=21.75, p=0.003), respiratory failure (OR=9.93, p<0.0001) and acute kidney injury (OR=16.28, p<0.014). CONCLUSION: Mortality is high among critically ill elderly patients. Factors associated with death were age, coma, hypotension, respiratory failure and acute kidney injury.CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológic

Treatment adherence and blood pressure control in older individuals with hypertension

FUNDAMENTO: A não adesão ao tratamento tem sido identificada como a causa principal da Pressão Arterial (PA) não controlada, e pode representar um risco maior em idosos. OBJETIVO: O objetivo deste estudo foi avaliar e comparar a taxa de adesão ao tratamento da hipertensão arterial por diferentes métodos, para estimar a taxa de controle da PA, e observar se há uma associação entre controle da pressão arterial e adesão. MÉTODOS: A adesão ao tratamento foi avaliada em pacientes idosos com hipertensão, acompanhados pelo serviço público de saúde, por meio de quatro métodos, incluindo o teste de Morisky-Green (referência), o questionário sobre atitudes referentes à ingestão de medicação (AMI), uma avaliação da adesão por parte do enfermeiro em consultório (AEC), e avaliação domiciliar da adesão (ADA). A ingestão de sal foi estimada pela excreção urinária de sódio de 24 horas. O controle da pressão arterial foi avaliado pelo monitorização ambulatorial da pressão arterial na vigília. RESULTADOS: A concordância entre o teste de Morisky-Green e o AMI (Kappa = 0,27) ou a AEC (Kappa = 0,05) foi pobre. Houve uma concordância moderada entre o teste de Morisky-Green e a ADA. Oitenta por cento tinham a PA controlada, incluindo 42% com efeito do jaleco branco. O grupo com menor excreção de sal relatou evitar o consumo de sal mais vezes (p < 0,001) e também teve maior adesão ao medicamento (p < 0,001) do que o grupo com maior de excreção de sal. CONCLUSÃO: Os testes avaliados não apresentaram boa concordância com o teste de Morisky-Green. A adesão ao tratamento da hipertensão foi baixa; no entanto, houve uma elevada taxa de controle da pressão arterial, quando os sujeitos com o efeito do jaleco branco foram incluídos na análise

Congnitive status, depression and biochemical indices as predictors of mortality in elderly subjects on haemodialysis

OBJECTIVES: To characterize the geriatric population under dialysis in a specialized center. To identify factors possibly involved with death risk in this population. METHODS: Sixty two volunteers, (83% of the older patients of that center, six were excluded) were submited to the application of the Mini-Mental State Examination (MMSE), the Clock-Drawing test (CDT), the Verbal Fluency test and the Geriatric Depression Scale (GDS). Biochemical tests were also performed. After 12 months, the patients' files were reassessed as to mortality and associated factors data. RESULTS: Volunteers alive after 12 months were younger (68.18 ± 5.7 years) than those that died (74.06 ± 7.36 years), p = 0.001. Male gender was predominant (60.7%). In alive and deceased groups, the results for blood tests were, respectively: parathormone 369.87 ± 318.90 and 368.50 ± 501.47 (p &gt; 0.05); creatinine 6.89 ± 2.05 and 5.23 ± 1.15 (p = 0.002); albumine 3.66 ± 0.35 and 3.74 ± 0.644 (p &gt; 0.05); total cholesterol 165.55 ± 45.16 and 169.35 ± 38.68 (p &gt; 0.05); triglycerides 144.57 ± 80.95 and 126.94 ± 77.71 (p &gt; 0.05); HDL 38.27 ± 14.26 and 44.22 ± 10.78 (p &gt; 0.05); calcium 9.40 ± 0.77 and 9.14 ± 0.68 (p &gt; 0.05); KT/V 1.64 ± 0.32 and 1.63 ± 0.27 (p &gt; 0.05). MMSE differed between groups (p = 0.03) and creatinine showed to be a potential death-related factor. GDS had similar scores between the two groups (p = 0.06). CONCLUSIONS: MMSE scores were directly associated with mortality in older patients submitted to hemodialysis. The correlation between lower serum creatinine level and mortality is possibly caused by a worse nutritional status of those patients.</p

Prevalence of functional cognitive impairment and associated factors in Brazilian community-dwelling older adults

ABSTRACT The identification of the prevalence of cognitive impairment and associated factors among older adults is important in countries facing rapid demographic transition, given the significant implications for public policy and health planning. Objective: To determine the prevalence of functional cognitive impairment (FCI) and associated factors in Brazilian community-dwelling older adults. Methods: A cross-sectional study involving 461 elderly subjects residing in Fortaleza city, Ceará was conducted. Cognitive assessment was performed using three tests: the MMSE (Mini-Mental State Examination), VF (Verbal Fluency) and CT (Clock Test). The functional capacity evaluation was based on a survey of 21 basic and instrumental activities of daily living (ADLs). Cognitive impairment was defined by MMSE cut-off points adjusted for literacy. Functional impairment was defined as dependency to carry out more than four ADLs. Results: The prevalence of FCI was 13.64% (95% CI: 10.33 to 16.64%). FCI was proportionally associated with age with OR=2.24 (95% CI: 1.04 to 4.79) for individuals aged 70 to 79 years and OR=8.27 (95 % CI: 4.27 to 16.4) for those aged 80 to 100 years. FCI was associated with self-reported diseases including hypertension OR=2.06 (95% CI: 1.17 to 3.65), stroke OR=2.88 (95% CI: 1.66 to 5.00) and acute myocardial infarction OR=2.94 (95% CI: 1.59 to 5.42). The occurrence of FCI was proportionally correlated with the number of drugs used. Conclusion: Functional cognitive impairment is a prevalent condition in Brazilian community-dwelling older adults and its occurrence is associated with age, number of drugs used, and vascular morbidities

Feasibility indicators of telemedicine for patients with dementia in a public hospital in Northeast Brazil during the COVID-19 pandemic.

BackgroundThe use of telemedicine has become a fundamental tool in healthcare in recent years, especially at times of Covid-19 pandemic. Currently, there are several telemedicine tools that are simple, inexpensive, and effective means of communication. This article aims to describe indicators of feasibility including patient recruitment, attendance, discomfort (internet connection issues and/or noncompliant patient behavior), satisfaction, and travel time and cost savings of virtual telemedicine consultations for patients with dementia.MethodsThe study was conducted at the Geriatrics Department of Hospital Universitário Walter Cantídio (HUWC) in Fortaleza, Brazil, between May 1st and December 31, 2020. The eligibility criteria included previous diagnosis of dementia syndrome and receiving care at the hospital's dementia outpatient clinic in face-to-face consultations in the preceding 12 months. Patients were excluded if they did not feel comfortable with virtual consultations, did not have the required communication technology available or their caregiver was not available to attend the remote consultation. The patients were recruited from the outpatient dementia clinic's medical appointment scheduling list. The intervention was designed as a one-time consultation and it included treatment approaches and health promotion recommendations.ResultsPatient recruitment, attendance and discomfort rates were 85.5%, 97.7% and 9.4%, respectively. To attend face-to-face visits, they reported an average travel time (including the consultation) of 233.21 minutes and average total cost of 60.61 reais (around USD 11). The study intervention was well accepted among the patients and their caregivers with 97.6% being satisfied. Many were happy to avoid long waits in crowded medical waiting rooms and the risk of covid-19 contagion.ConclusionsWe found good recruitment, attendance, and acceptance rates of remote care for the follow-up of dementia patients as well as low discomfort rates.Trial registrationBrazilian Trial Registry (REBEC) RBR-9xs978