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

Crise hipertensiva: atuação da enfermagem em uma unidade de emergência / Hypertensive crisis: nurse performance in emergency room

As complicações da hipertensão arterial surgem em decorrência da falta de adaptação do cliente à doença e ao tratamento. As intervenções de enfermagem minimizam as consequências e sequelas da doença.Objetivo:Descrever a importância de um atendimento eficaz e de intervenções necessárias realizadas pelo enfermeiro em unidades de emergência à pacientes de Crise Hipertensiva. Método: Estudo bibliográfico utilizando os seguintes descritores: “crise hipertensiva”, “emergência hipertensiva”, “enfermeiro”e “a equipe de enfermagem nas emergências.Aconsulta baseou-se em artigos científicos, teses e dissertações disponíveisnas plataformas LILACS, SCIELO e MEDLINE. Resultados: A hipertensão é uma doença crônica popularmente conhecida como “pressão alta”, a qual uma pessoa hipertensa apresenta valores iguais ou acima de 135 mmHg X 85 mmHg quando se mede a pressão arterial em repouso. É muito comum e acomete uma em cada quatro pessoas adultas. Conclusão: Conclui-se que a qualidade dos serviços de enfermagem diante de uma crise hipertensiva é de suma importante para o paciente. A atuação do enfermeiro nas ações de humanização são as principais estratégias para melhoria do atendimento

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

An In Silico and an In Vitro Inhibition Analysis of Glycogen Phosphorylase by Flavonoids, Styrylchromones, and Pyrazoles

Glycogen phosphorylase (GP) is a key enzyme in the glycogenolysis pathway. GP inhibitors are currently under investigation as a new liver-targeted approach to managing type 2 diabetes mellitus (DM). The aim of the present study was to evaluate the inhibitory activity of a panel of 52 structurally related chromone derivatives; namely, flavonoids, 2-styrylchromones, 2-styrylchromone-related derivatives [2-(4-arylbuta-1,3-dien-1-yl)chromones], and 4- and 5-styrylpyrazoles against GP, using in silico and in vitro microanalysis screening systems. Several of the tested compounds showed a potent inhibitory effect. The structure&ndash;activity relationship study indicated that for 2-styrylchromones and 2-styrylchromone-related derivatives, the hydroxylations at the A and B rings, and in the flavonoid family, as well as the hydroxylation of the A ring, were determinants for the inhibitory activity. To support the in vitro experimental findings, molecular docking studies were performed, revealing clear hydrogen bonding patterns that favored the inhibitory effects of flavonoids, 2-styrylchromones, and 2-styrylchromone-related derivatives. Interestingly, the potency of the most active compounds increased almost four-fold when the concentration of glucose increased, presenting an IC50 &lt; 10 &micro;M. This effect may reduce the risk of hypoglycemia, a commonly reported side effect of antidiabetic agents. This work contributes with important considerations and provides a better understanding of potential scaffolds for the study of novel GP inhibitors