Análise descritiva dos pacientes submetidos à extubação paliativa

Dissertação (mestrado profissional) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Cuidados Intensivos e Paliativos, Florianópolis, 2015O desenvolvimento tecnológico do mundo atual tem permitido o prolongamento do morrer, principalmente em unidades de terapia intensiva (UTI). Torna-se crescente a necessidade de decisões de limite de esforço terapêutico (LET), do qual se destaca a extubação paliativa, que embora difícil de ser aceita do ponto de vista emocional, tem respaldo ético-legal e aumenta a satisfação familiar.Objetivo: Avaliar o perfil clínico-demográfico dos pacientes extubados paliativamente (ExPl) na UTI do Hospital Universitário da Universidade Federal de Santa Catarina (HU/UFSC).Método: Coorte histórico, cujos dados foram coletados através das fichas preenchidas por médicos intensivistas que constituem a Comissão de Óbito da instituição. Foram incluídos os pacientes que morreram na UTI/HU/UFSC, após indicação de LET, entre janeiro/2011 e dezembro/2014. Foram selecionados os pacientes que foram ExPl, sendo anotados seus dados clínicos e epidemiológicos.Resultados: LET foi apontado em 374 (53,8%) pacientes, sendo 23 (6,1%) ExPl. A média da idade dos ExPl foi de 73,8 anos, 10 tinham mais de 60 e 9 mais de 80 anos. Dez (43,4%) pacientes já haviam sido internados previamente em UTI. O tempo médio entre a internação-extubação foi 4,4 dias e entre extubação-morte foi de 2,5 dias. Doença neurológica foi a principal causa da morte dos pacientes ExPl. Todos os familiares estavam cientes da extubação. Familiares de 2 pacientes acompanharam a extubação. Morfina foi a medicação analgésica mais prescrita.Conclusão: Os pacientes que foram ExPl eram mais idosos, acometidos preferencialmente por doenças neurológicas e o tempo médio entre a extubação e o óbito foi de 2,5 dias. Abstract : Current technological advancements have allowed the extension of the dying process, especially in Intensive Care Units (ICU). This has increased the need for decisions on the limitation of therapeutic effort (LTE), such as the use of palliative extubation that, although difficult from an emotional standpoint, has legal and ethical justifications, and increased family acceptance. Objective: Evaluate the clinical and demographical profile of patients submitted to palliative extubation (PT) in the ICU of the University Hospital of the Universidade Federal de Santa Catarina (HU/UFSC), Brazil. Method: Historical cohort data obtained from forms filled out by critical care doctors from the Obituary Committee at the HU/UFSC. Patients submitted to LTE that died between January 2011 and December 2014 were included in the study. The use of PT and clinical and epidemiological data was collected. Results: LTE was indicated in 374 (53.8%) patients, with 23 (6.1%) receiving PT. Average age of patients undergoing PT was 73.8 years; 10 patients were over 60 and 9 were over 80 years of age. Ten (43.4%) patients had been previously in the ICU. The average time from checking in the ICU and extubation was 4.4 days, and between extubation and death was 2.5 days. Neurologic disease was the main cause of death of patients under PT. All family members were aware of the extubation. Family members from 2 families witnessed the extubation. Morphine was the most common analgesic prescribed. Conclusions: Patients submitted to PT were older, with neurologic disease, and the average time from extubation to death was 2.5 days

COMPARAÇÃO DOS EFEITOS ENTRE A BANDAGEM FUNCIONAL DE IMOBILIZAÇÃO E DE CONTENÇÃO NO TRATAMENTO DA FASCITE PLANTAR

A Fascite plantar é ocasionada por uma força de tração repetida da fáscia plantar, levando a um processo inflamatório e degenerativo da aponeurose, resultando em dor na região. O tratamento convencional da Fascite plantar consiste em constantes alongamentos da fáscia plantar e do tríceps sural (músculos gastrocnêmios medial/lateral e sóleo). Entretanto, a aplicação das bandagens funcionais também vem mostrando resultados importantes no tratamento dessa patologia, pois reduzem a tensão sobre a fáscia e nas estruturas mediais do arco. O objetivo desse estudo foi comparar os efeitos entre a bandagem funcional de imobilização e de contenção no tratamento da Fascite plantar. Metodologia: Foi realizado um estudo transversal randomizado, com uma amostra composta por 21 pessoas com fascite plantar que foram divididas em três grupos, grupo 1 (exercícios de alongamento), grupo 2 (exercícios de alongamento + bandagem de imobilização), e grupo 3 (exercícios de alongamento + bandagem de contensão). A avaliação foi realizada através de uma ficha de anamnese, exame físico, questionários: AOFAS e IPAQ (versão curta) e ultrassonografia da Fáscia plantar. Para análise dos dados, utilizaram-se os programas computacionais Excel 2013 e o Software SPSS versão 20.0 for Windows. Os escores foram descritos por medidas estatísticas: média, mínimo, moda, mediana e máximo. A análise de cada variável foi analisada por grupos através de ANOVA para os dados normais (flexibilidade e espessamento) e Kruskal-Wallis para os dados não normais (EVA e AOFAS). Neste estudo com relação a plantigrafia observou uma mudança do tipo de pé do início par ao final do estudo, no início do estudo 21% dos participantes tinham uma flexibilidade <23cm no banco de Wells, após a intervenção 14%, 33% dos participantes melhoraram a classificação segundo o questionário de AOFAS. O estudo demonstrou não haver diferenças estatisticamente significativas entre os grupos estudados

Molecular serotyping of clinical strains of Haemophilus (Glaesserella) parasuis brings new insights regarding Glässer’s disease outbreaks in Brazil

[EN]Glässer's disease (GD) is an important infectious disease of swine caused by Haemophilus (Glaesserella) parasuis. Vaccination with inactivated whole cell vaccines is the major approach for prevention of H. parasuis infection worldwide, but the immunity induced is predominantly against the specific polysaccharide capsule. As a consequence, the available vaccines may not induce adequate protection against the field strains, when the capsules present in the vaccine strains are different from those in strains isolated from the farms. Therefore, it is crucial to map H. parasuis serovars associated with regional outbreaks so that appropriate bacterin vaccines can be developed and distributed for prevention of infection. In this study, 459 H. parasuis field strains isolated from different Glässer's disease outbreaks that occurred in 10 different Brazilian States were analyzed for serotype using PCR-based approaches. Surprisingly, non-Typeable (NT) strains were the second most prevalent group of field strains and along with serovars 4, 5 and 1 comprised more than 70% of the isolates. A PCRbased approach designed to amplify the entire polysaccharide capsule locus revealed 9 different band patterns in the NT strains, and 75% of the NT strains belonged to three clusters, suggesting that a number of new serovars are responsible for a substantial proportion of disease. These results indicate that commercially available vaccines in Brazil do not cover the most prevalent H. parasuis serovars associated with GD.SIThis study was funded by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, grant 485807/2013-0) and by the Secretaria de Desenvolvimento Econômico Ciência e Tecnologia do Rio Grande do Sul (SDECT, grant 328-2500/14-0). Julia Pires Espíndola and Letícia Trevisan Gressler were supported by Coordenação de Aperfeiçoamento de Pessoal de Ensino Superior (CAPES) Master and Postdoctoral fellowship, respectively. Natalia Balbinott was supported by a CNPq undergraduate fellowship. Luiz Carlos Kreutz has a CNPq PQ fellowship (307900/2016-9). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Molecular serotyping of clinical strains of Haemophilus (Glaesserella) parasuis brings new insights regarding Glässer’s disease outbreaks in Brazil

Glässer’s disease (GD) is an important infectious disease of swine caused by Haemophilus (Glaesserella) parasuis. Vaccination with inactivated whole cell vaccines is the major approach for prevention of H. parasuis infection worldwide, but the immunity induced is predominantly against the specific polysaccharide capsule. As a consequence, the available vaccines may not induce adequate protection against the field strains, when the capsules present in the vaccine strains are different from those in strains isolated from the farms. Therefore, it is crucial to map H. parasuis serovars associated with regional outbreaks so that appropriate bacterin vaccines can be developed and distributed for prevention of infection. In this study, 459 H. parasuis field strains isolated from different Glässer’s disease outbreaks that occurred in 10 different Brazilian States were analyzed for serotype using PCR-based approaches. Surprisingly, non-typeable (NT) strains were the second most prevalent group of field strains and along with serovars 4, 5 and 1 comprised more than 70% of the isolates. A PCR-based approach designed to amplify the entire polysaccharide capsule locus revealed 9 different band patterns in the NT strains, and 75% of the NT strains belonged to three clusters, suggesting that a number of new serovars are responsible for a substantial proportion of disease. These results indicate that commercially available vaccines in Brazil do not cover the most prevalent H. parasuis serovars associated with GD

Current Scenario of Clinical Cancer Research in Latin America and the Caribbean

In Latin America and the Caribbean (LAC), progress has been made in some national and regional cancer control initiatives, which have proved useful in reducing diagnostic and treatment initiation delays. However, there are still significant gaps, including a lack of oncology clinical trials. In this article, we will introduce the current status of the region’s clinical research in cancer, with a special focus on academic cancer research groups and investigator-initiated research (IIR) initiatives. Investigators in LAC have strived to improve cancer research despite drawbacks and difficulties in funding, regulatory timelines, and a skilled workforce. Progress has been observed in the representation of this region in clinical trial development and conduct, as well as in scientific productivity. However, most oncology trials in the region have been sponsored by pharmaceutical companies, highlighting the need for increased funding from governments and private foundations. Improvements in obtaining and/or strengthening the LAC cancer research group’s financing will provide opportunities to address cancer therapies and management shortcomings specific to the region. Furthermore, by including this large, ethnic, and genetically diverse population in the world’s research agenda, one may bridge the gap in knowledge regarding the applicability of results of clinical trials now mainly conducted in populations from the Northern Hemisphere

Perspectives on emerging technologies, personalised medicine, and clinical research for cancer control in Latin America and the Caribbean

Challenges of health systems in Latin America and the Caribbean include accessibility, inequity, segmentation, and poverty. These challenges are similar in different countries of the region and transcend national borders. The increasing digital transformation of health care holds promise of more precise interventions, improved health outcomes, increased efficiency, and ultimately reduced health-care costs. In Latin America and the Caribbean, the adoption of digital health tools is in early stages and the quality of cancer registries, electronic health records, and structured databases are problematic. Cancer research and innovation in the region are limited due to inadequate academic resources and translational research is almost fully dependent on public funding. Regulatory complexity and extended timelines jeopardise the potential improvement in participation in international studies. Emerging technologies, artificial intelligence, big data, and cancer research represent an opportunity to address the health-care challenges in Latin America and the Caribbean collectively, by optimising national capacities, sharing and comparing best practices, and transferring scientific and technical capabilities.Fil: Werutsky, Gustavo. No especifíca;Fil: Barrios, Carlos H.. No especifíca;Fil: Cardona, Andres F.. No especifíca;Fil: Albergaria, André. No especifíca;Fil: Valencia, Alfonso. No especifíca;Fil: Ferreira, Carlos G.. No especifíca;Fil: Rolfo, Christian. No especifíca;Fil: de Azambuja, Evandro. Université Libre de Bruxelles; BélgicaFil: Rabinovich, Gabriel Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Sposetti, Georgina. No especifíca;Fil: Arrieta, Oscar. No especifíca;Fil: Dienstmann, Rodrigo. No especifíca;Fil: Rebelatto, Taiane F.. No especifíca;Fil: Denninghoff, Valeria Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Aran, Veronica. No especifíca;Fil: Cazap, Eduardo. No especifíca

Perspectives on emerging technologies, personalised medicine, and clinical research for cancer control in Latin America and the Caribbean

Challenges of health systems in Latin America and the Caribbean include accessibility, inequity, segmentation, and poverty. These challenges are similar in different countries of the region and transcend national borders. The increasing digital transformation of health care holds promise of more precise interventions, improved health outcomes, increased efficiency, and ultimately reduced health-care costs. In Latin America and the Caribbean, the adoption of digital health tools is in early stages and the quality of cancer registries, electronic health records, and structured databases are problematic. Cancer research and innovation in the region are limited due to inadequate academic resources and translational research is almost fully dependent on public funding. Regulatory complexity and extended timelines jeopardise the potential improvement in participation in international studies. Emerging technologies, artificial intelligence, big data, and cancer research represent an opportunity to address the health-care challenges in Latin America and the Caribbean collectively, by optimising national capacities, sharing and comparing best practices, and transferring scientific and technical capabilities.SCOPUS: re.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Cancer control in Latin America and the Caribbean: Recent advances and opportunities to move forward

The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean

IFI27 transcription is an early predictor for COVID-19 outcomes; a multi-cohort observational study

Robust biomarkers that predict disease outcomes amongst COVID-19 patients are necessary for both patient triage and resource prioritisation. Numerous candidate biomarkers have been proposed for COVID-19. However, at present, there is no consensus on the best diagnostic approach to predict outcomes in infected patients. Moreover, it is not clear whether such tools would apply to other potentially pandemic pathogens and therefore of use as stockpile for future pandemic preparedness. We conducted a multi-cohort observational study to investigate the biology and the prognostic role of interferon alpha-inducible protein 27 (IFI27) in COVID-19 patients. We show that IFI27 is expressed in the respiratory tract of COVID-19 patients and elevated IFI27 expression is associated with the presence of a high viral load. We further demonstrate that systemic host response, as measured by blood IFI27 expression, is associated with COVID-19 severity. For clinical outcome prediction (e.g. respiratory failure), IFI27 expression displays a high positive (0.83) and negative (0.95) predictive value, outperforming all other known predictors of COVID-19 severity. Furthermore, IFI27 is upregulated in the blood of infected patients in response to other respiratory viruses. For example, in the pandemic H1N1/09 swine influenza virus infection, IFI27-like genes were highly upregulated in the blood samples of severely infected patients. These data suggest that prognostic biomarkers targeting the family of IFI27 genes could potentially supplement conventional diagnostic tools in future virus pandemics, independent of whether such pandemics are caused by a coronavirus, an influenza virus or another as yet-to-be discovered respiratory virus. We searched the scientific literature using PubMed to identify studies that used the IFI27 biomarker to predict outcomes in COVID-19 patients. We used the search terms “IFI27”, “COVID-19, “gene expression” and “outcome prediction”. We did not identify any study that investigated the role of IFI27 biomarker in outcome prediction. Although ten studies were identified using the general terms of “gene expression” and “COVID-19”, IFI27 was only mentioned in passing as one of the identified genes. All these studies addressed the broader question of the host response to COVID-19; none focused solely on using IFI27 to improve the risk stratification of infected patients in a pandemic. Here, we present the findings of a multi-cohort study of the IFI27 biomarker in COVID-19 patients. Our findings show that the host response, as reflected by blood IFI27 gene expression, accurately predicts COVID-19 disease progression (positive and negative predictive values; 0.83 and 0.95, respectively), outperforming age, comorbidity, C-reactive protein and all other known risk factors. The strong association of IFI27 with disease severity occurs not only in SARS-CoV-2 infection, but also in other respiratory viruses with pandemic potential, such as the influenza virus. These findings suggest that host response biomarkers, such as IFI27, could help identify high-risk COVID-19 patients - those who are more likely to develop infection complications - and therefore may help improve patient triage in a pandemic. This is the first systemic study of the clinical role of IFI27 in the current COVID-19 pandemic and its possible future application in other respiratory virus pandemics. The findings not only could help improve the current management of COVID-19 patients but may also improve future pandemic preparedness