Evaluation of a program of Cardiovascular Rehabilitation Phase 1 modified for patients submitted to a surgery for Coronary artery bypass graft

The coronary heart disease is the major cause of morbidity and mortality in the modern world. Its surgical treatment for coronary artery bypass grafting (CABG), aims to improve the functioning and the prognostic state. Physiotherapy and cardiac rehabilitation programs have an important role in the patient recuperation after the surgical treatment for coronary artery bypass grafting (CABG). The program rehabilitation should be initiated as early as possible to reduce the deleterious effects of prolonged bed rest, establish the intensity of the effort scheduled, and reduce the patient permanence in the hospital. The objective of this study was to compare the walking distance by patients undergoing CABG following the standard protocol for cardiac rehabilitation (Emory School of Medicine) with a new suggested protocol (modified protocol by Department of cardiac rehabilitation of Faculty of Physiotherapy, University of Franca – UNIFRAN). Data from 37 patients that have undergone CABG at the Hear Hospital “Octávio Quercia” of Franca, included in the group of hospital rehabilitation (Phase I), was analyzed in this study. These patients were submitted to walking just after discharge from the intensive care unit (ICU). The program started with two walking sessions daily, each one having twenty minutes that was gradually increased in accordance with the patient tolerance. The suggested protocol showed a better performance than the standard protocol. The patients following the new protocol walked a larger distance than those following the standard protocol, reduced the length of hospital staying

Evaluation of the effect of hypothermia by cold water immersion on blood neutrophils and lymphocytes of rats submitted to acute exercise

O estresse sistêmico induzido pelo exercício libera substâncias bioativas determinantes da mobilização neutrofílica. A crioterapia diminui a reação inflamatória e atenua a elevação da perfusão sanguínea induzida pelo exercício. O objetivo deste trabalho foi analisar a influência da hipotermia decorrente da crioimersão corporal (CIC) imediata ao esforço físico agudo nas concentrações neutrofílicas e linfocíticas no sangue. Os ratos do grupo controle (AI) foram mantidos em repouso enquanto os do grupo AII foram submetidos ao protocolo de CIC a 10ºC por 10 minutos. Enquanto os animais dos grupos BI, BII, BIII e BIV realizaram o esforço físico agudo (EFA) em água a 31ºC durante 100 minutos com sobrecarga corpórea de 5% do peso corporal, os dos grupos CI, CII, CIII e CIV foram submetidos ao EFA seguido imediatamente de CIC. Nos grupos B e C, os animais foram sacrificados nos períodos de 06 (I), 12 (II), 24 (III) e 48 (IV) horas posteriores ao EFA. Através da microscopia óptica realizou-se a contagem dos neutrófilos e linfócitos. Utilizou-se do Teste T Student para análise estatística considerando-se nível de significância p < 0,05. Observou-se uma significativa neutrofilia nos grupos AII, BI, BII, BIII, BIV, CI, CII e CIII em relação a AI, diferentemente do grupo CIV, que apresentou quantidade de neutrófilos igual ao grupo controle. Os valores de linfócitos nos grupos BII, BIII, BIV, CI e CII foram significativamente menores do que AI, e nos grupos AII, BI, CIII e CIV foram iguais a AI. A neutrofilia e a linfopenia posteriores ao intenso exercício agudo são mantidas por 48 horas ou mais, porém, mediante a aplicação da crioimersão corporal imediata ao exercício, são normalizadas em 24 horas.Systemic stress induced by exercise increases bioactive substances in plasma which leads to neutrophilic mobilization. Cryotherapy causes a decrease in the inflammatory reaction and attenuates high blood perfusion after exercise. The objective of this work was to analyze the influence of cold water immersion (CWI) after acute exercise on neutrophil and lymphocyte mobilization. A control group of rats (AI) was kept at rest and a second group (AII) was submitted to CWI at 10º C for 10 minutes. The animals of Groups BI, BII, BIII and BIV were submitted to acute exercise which consisted in swimming in water at 31º C for 100 minutes with a load equivalent to 5% of the body weight. Groups CI, CII, CIII and CIV were submitted to CWI immediately after acute exercise. The animals were sacrificed at 6 (I), 12 (II), 24 (III) and 48 (IV) hours after the exercise and neutrophil and lymphocyte cells were counted for all groups by optic microscopy. The Student t-test was used for statistical analysis with a significance level of p< 0.05. A significant increase in the number of neutrophils was observed in Groups AII, BI, BII, BIII, BIV, CI, CII and CIII compared to AI. The neutrophil count of the CIV Group was similar to the Control Group. There was a significant drop in the number of lymphocytes in Groups BII, BIII, BIV, CI and CII when compared to Group AI. The lymphocyte count of Groups AII, BI, CIII and CIV were similar to the Control Group. The changes in neutrophil and lymphocyte counts caused by acute exercise were reverted to normal at 24 hours by cold water immersion

Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

Background: Urinary tract infection (UTI) is one of the most common sources of infection in children under five. Prompt diagnosis and treatment is important to reduce the risk of renal scarring. Rapid, cost-effective, methods of UTI diagnosis are required as an alternative to culture. Methods: We conducted a systematic review to determine the diagnostic accuracy of rapid tests for detecting UTI in children under five years of age. Results: The evidence supports the use of dipstick positive for both leukocyte esterase and nitrite (pooled LR+ = 28.2, 95% CI: 17.3, 46.0) or microscopy positive for both pyuria and bacteriuria (pooled LR+ = 37.0, 95% CI: 11.0, 125.9) to rule in UTI. Similarly dipstick negative for both LE and nitrite (Pooled LR- = 0.20, 95% CI: 0.16, 0.26) or microscopy negative for both pyuria and bacteriuria (Pooled LR- = 0.11, 95% CI: 0.05, 0.23) can be used to rule out UTI. A test for glucose showed promise in potty-trained children. However, all studies were over 30 years old. Further evaluation of this test may be useful. Conclusion: Dipstick negative for both LE and nitrite or microscopic analysis negative for both pyuria and bacteriuria of a clean voided urine, bag, or nappy/pad specimen may reasonably be used to rule out UTI. These patients can then reasonably be excluded from further investigation, without the need for confirmatory culture. Similarly, combinations of positive tests could be used to rule in UTI, and trigger further investigation

Lessons From The Epidemiological Surveillance Program, During The Influenza A (h1n1) Virus Epidemic, In A Reference University Hospital Of Southeastern Brazil [lições Aprendidas Pelo Programa De Vigilância Epidemiológica, Durante A Epidemia Pelo Vírus Da Influenza A (h1n1), Em Um Hospital Universitário Na Região Sudeste Do Brasil]

Introduction: The case definition of influenza-like illness (ILI) is a powerful epidemiological tool during influenza epidemics. Methods: A prospective cohort study was conducted to evaluate the impact of two definitions used as epidemiological tools, in adults and children, during the influenza A H1N1 epidemic. Patients were included if they had upper respiratory samples tested for influenza by real-time reverse transcriptase polymerase chain reaction during two periods, using the ILI definition (coughing + temperature ≥ 38°C) in period 1, and the definition of severe acute respiratory infection (ARS) (coughing + temperature ≥ 38°C and dyspnoea) in period 2. Results: The study included 366 adults and 147 children, covering 243 cases of ILI and 270 cases of ARS. Laboratory confirmed cases of influenza were higher in adults (50%) than in children (21.6%) (p < 0.0001) and influenza infection was more prevalent in the ILI definition (53%) than ARS (24.4%) (p < 0.0001). Adults reported more chills and myalgia than children (p = 0.0001). Oseltamivir was administered in 58% and 46% of adults and children with influenza A H1N1, respectively. The influenza A H1N1 case fatality rate was 7% in adults and 8.3% in children. The mean time from onset of illness until antiviral administration was 4 days. Conclusions: The modification of ILI to ARS definition resulted in less accuracy in influenza diagnosis and did not improve the appropriate time and use of antiviral medication.444405411Dawood, F.S., Jain, S., Finelli, L., Shaw, M.W., Lindstrom, S., Emergence of a novel swineorigin influenza A (H1N1) virus in humans (2009) N Engl J Med, 360, pp. 2605-2615. , Novel swine-origin influenza A (H1N1) virus investigation team, et alPeiris, J.S., Poon, L.L., Guan, Y., Emergence of a novel swine-origin influenza A virus (S-OIV) H1N1 virus in humans (2009) J Clin Virol, 45, pp. 169-173Antigenic and genetic characteristics of swine-origin 2009 A (H1N1) influenza viruses circulating in humans (2009) Science, 325, pp. 197-201. , WHO Collaborating Center for Influenza, Centers for Disease Control and Prevention, et alSmith, G.J.D., Vijaykrishna, D., Bahl, J., Lycett, S.J., Worobey, M., Pybus, O.G., Origins and evolutionary genomics of the 2009 swine-origin H1N1 influenza A epidemic (2009) Nature, 450, pp. 1122-1126Oliveira, W.K., Penna, G., Kuchenbecker, R., Santos, H., Araujo, W., (2009) Pandemic H1N1 Influenza in Brazil: Analysis of the First 34,506 Notified Cases of Influenza-like Illness with Severe Acute Respiratory Infection (SARI), , http://www.eurosurveillance.org/viewarticle.aspx?articleid=19362/, Surveillance Team for the pandemic influenza A(H1N1) 2009 in the Ministry of Health, et al, Euro Surveill, Available fromBerts, R.F., Flu virus (1995) Principles and Practice of Infectious Diseases, pp. 1546-1567. , In: Mandell GL, Bennett JE, Dolin R, editors, 4th ed. New York: Churchill LivingstoneBoivin, G., Hardy, I., Tellier, G., Maziade, J., Predicting flu infections during epidemics with the use of a clinical definition (2000) Clin Infect Dis, 31, pp. 1166-1169Monto, A.S., Gravenstein, S., Elliott, M., Colopy, M., Schweinle, J., Clinical signs and symptoms predicting influenza infection (2000) Arch Int Med, 160, pp. 3243-3247Ong, A.K., Chen, M.I., Lin, L., Tan, A.S., Nwe, N.W., Barkham, T., A comparative analysis of new influenza A (H1N1) cases (2009) PlosONE, 4, pp. e8453. , Improving the clinical diagnosis of influenzaChan, M.C., Chan, R.W., Yu, W.C., Ho, C.C., Yuen, K.M., Fong, J.H., Tropism and innate host responses of the 2009 pandemic H1N1 influenza virus in ex vivo and in vitro cultures of human conjunctiva and respiratory tract (2010) Am J Pathol, 176, pp. 1828-1840O'Riordan, S., Barton, M., Yau, Y., Read, S.E., Allen, U., Tran, D., Risk factors and outcomes among children admitted to hospital with pandemic H1N1 influenza (2010) CMAJ, 182, pp. 39-44Babcock, H.M., Merz, L.R., Fraser, V.J., Is influenza an influenza-like illness? Clinical presentation of influenza in hospitalized patients (2006) Infect Control Hosp Epidemiol, 27, pp. 266-270Kelly, H., Birch, C., The causes and diagnosis of influenza-like illness (2004) Aust Family Physician, 33, pp. 305-309Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection (2010) N Engl J Med, 362, pp. 1708-1719. , Writing Committee of the WHO consultation on Clinical Aspects of Pandemic (H1N1) 2009 InfluenzaPresanis, A.M., de Angelis, D., Hagy, A., Reed, C., Riley, S., The severity of pandemic H1N1 influenza in the United States from April to July 2009: A Bayesian analysis (2009) PLoS Med, 6, pp. e1000207. , New York City Swine Flu Investigation TeamDonaldson, L.J., Rutter, P.D., Ellis, B.M., Greaves, F.E., Mytton, O.T., Pebody, R.G., Mortality from pandemic A/H1N1 2009 influenza in England: Public health surveillance study (2009) BMJ, 339, pp. b5213(2010), http://portal.salud.gov.mx/contenidos/noticias/influenza/estadisticas.html/, Secretaria de Salud Mexico. 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Available fromEchavarría, M., Querci, M., Marcone, D., Videla, C., Martinez, A., Bonvehi, P., Pandemic (H1N1) 2009 cases, Buenos Aires, Argentina (2010) Emerg Infect Dis, 16, pp. 311-313Uyeki, T., Diagnostic testing for 2009 pandemic influenza A (H1N1) virus infection in hospitalized patients (2009) N Engl J Med, 361, pp. e114Blyth, C.C., Iredell, J.R., Dwyer, D.E., Rapid-test sensitivity for novel swine-origin influenza A (H1N1) virus in humans (2009) N Engl J Med, 361, p. 25Lee, N., Chan, P.K., Hui, D.S., Rainer, T.H., Wong, E., Choi, K.W., Viral loads and duration of viral shedding in adult patients hospitalized with influenza (2009) J Infect Dis, 200, pp. 492-500Chang, Y.S., van Hal, S.J., Spencer, P.M., Gosbell, I.B., Collett, P.W., Comparison of adult patients hospitalized with pandemic (H1N1) 2009 influenza and seasonal influenza during the "PROJECT" phase of the pandemic response (2010) Med J Aust, 192, pp. 90-93Shieh, W., Blau, D.M., Denison, A.M., Deleon-Carnes, M., Adem, P., Bhatnagar, J., 2009 pandemic influenza A (H1N1): Pathology and pathogenesis of 100 fatal cases in the United States (2010) Am J Pathol, 177, pp. 166-17

How does study quality affect the results of a diagnostic meta-analysis?

Background: The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods: This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results: Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. Conclusion: Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited

Leukocyte counts in urine reflect the risk of concomitant sepsis in bacteriuric infants: A retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>When urine infections are missed in febrile young infants with normal urinalysis, clinicians may worry about the risk – hitherto unverified – of concomitant invasion of blood and cerebrospinal fluid by uropathogens. In this study, we determine the extent of this risk.</p> <p>Methods</p> <p>In a retrospective cohort study of febrile 0–89 day old infants evaluated for sepsis in an urban academic pediatric emergency department (1993–1999), we estimated rates of bacteriuric sepsis (urinary tract infections complicated by sepsis) after stratifying infants by urine leukocyte counts higher, or lower than 10 cells/hpf. We compared the global accuracy of leukocytes in urine, leukocytes in peripheral blood, body temperature, and age for predicting bacteruric sepsis. The global accuracy of each test was estimated by calculating the area under its receiver operating characteristic curve (AUC). Chi-square and Fisher exact tests compared count data. Medians for data not normally distributed were compared by the Kruskal-Wallis test.</p> <p>Results</p> <p>Two thousand two hundred forty-nine young infants had a normal screening dipstick. None of these developed bacteremia or meningitis despite positive urine culture in 41 (1.8%). Of 1516 additional urine specimens sent for formal urinalysis, 1279 had 0–9 leukocytes/hpf. Urine pathogens were isolated less commonly (6% vs. 76%) and at lower concentrations in infants with few, compared to many urine leukocytes. Urine leukocytes (AUC: 0.94) were the most accurate predictors of bacteruric sepsis. Infants with urinary leukocytes < 10 cells/hpf were significantly less likely (0%; CI:0–0.3%) than those with higher leukocyte counts (5%; CI:2.6–8.7%) to have urinary tract infections complicated by bacteremia (N = 11) or bacterial meningitis (N = 1) – relative risk, 0 (CI:0–0.06) [RR, 0 (CI: 0–0.02), when including infants with negative dipstick]. Bands in peripheral blood had modest value for detecting bacteriuric sepsis (AUC: 0.78). Cases of sepsis without concomitant bacteriuria were comparatively rare (0.8%) and equally common in febrile young infants with low and high concentrations of urine leukocytes.</p> <p>Conclusion</p> <p>In young infants evaluated for fever, leukocytes in urine reflect the likelihood of bacteriuric sepsis. Infants with urinary tract infections missed because of few leukocytes in urine are at relatively low risk of invasive bacterial sepsis by pathogens isolated from urine.</p

INTESTINAL AND PULMONARY INFECTION BY Cryptosporidium parvum IN TWO PATIENTS WITH HIV/AIDS

We describe two patients with HIV/AIDS who presented pulmonary and intestinal infection caused by Cryptosporidium parvum, with a fatal outcome. The lack of available description of changes in clinical signs and radiographic characteristics of this disease when it is located in the extra-intestinal region causes low prevalence of early diagnosis and a subsequent lack of treatment