Associação entre proteína 1 relacionada à uteroglobulina e gravidade da lesão por inalação de fumaça

Objective: To evaluate serum uteroglobin-related protein 1 expression early after smoke inhalation injuries and its association with the severity of inhalation injury in burned patients. Methods: Smoke or chemical inhalation injury is associated with morbidity and mortality. The consequences of inhalation result from an inflammatory response. Uteroglobin-related protein 1 is an anti-inflammatory protein and may improve lung inflammation. We hypothesized that uteroglobin-related protein 1 levels could reflect disease severity and predict outcome in patients with inhalation injury. Sixteen patients diagnosed with acute respiratory distress syndrome secondary to smoke inhalation injury were prospectively included in the study. Plasma was collected upon intensive care unit admission and within 24 hours of the inhalation injury. Bronchoscopies were carried out in all patients to assess the severity of inhalation injury within 72 hours. Uteroglobin-related protein 1 plasma levels were determined in duplicate with enzyme-linked immunosorbent assay. Results: The mean age was 23 ± 5 years, and the inhalation injury distribution was as follows: three of grade 1, four of grade 2, and nine of grade 3. The level of uteroglobin-related protein 1 was related to inhalation severity (grade 1: 0.389 ± 0.053 arbitrary units versus grade 2: 0.474 ± 0.0423 arbitrary units versus grade 3: 0.580 ± 0.094 arbitrary units; p = 0.007). Conclusion: Plasma levels of uteroglobin-related protein 1 are associated with the degree of lung inhalation injury.Objetivo: Avaliar a expressão sérica da proteína 1 relacionada à uteroglobulina na fase inicial após lesões por inalação de fumaça e sua associação com a gravidade da lesão por inalação em pacientes queimados. Métodos: A lesão por inalação de fumaça ou produtos químicos se associa com morbidade e mortalidade. As consequências da inalação resultam de uma resposta inflamatória. A proteína 1 relacionada à uteroglobulina é anti-inflamatória e pode melhorar a inflamação pulmonar. Nossa hipótese é que os níveis de proteína 1 relacionada à uteroglobulina podem refletir a gravidade da doença e predizer o desfecho em pacientes com lesão por inalação. Incluíram-se prospectivamente neste estudo 16 pacientes com diagnóstico de síndrome do desconforto respiratório agudo decorrente de lesão por inalação de fumaça. Em todos os pacientes, colheu-se amostra de plasma quando da admissão à unidade de terapia intensiva, para avaliar a gravidade da lesão por inalação dentro de 72 horas. Os níveis plasmáticos de proteína 1 relacionada à uteroglobulina foram determinados em duplicata por meio de ensaio de imunoabsorção ligado à enzima. Resultados: A média de idade foi de 23 ± 5 anos, e a distribuição da lesão por inalação foi: três em grau 1, quatro em grau 2 e nove em grau 3. O nível de proteína 1 relacionada à uteroglobulina foi relacionado ao grau de severidade (grau 1: 0,389 ± 0,053 unidade arbitrária versus grau 2: 0,474 ± 0,0423 unidade arbitrária versus grau 3: 0,580 ± 0,094 unidade arbitrária; p = 0,007). Conclusão: Os níveis plasmáticos de proteína 1 relacionada à uteroglobulina se associam com o grau da lesão pulmonar por inalação

Enteral nutrition discontinuation and outcomes in general critically ill patients

OBJECTIVE: To determine the relationship between enteral nutrition discontinuation and outcome in general critically ill patients. MATERIALS AND METHODS: All patients admitted to a mixed intensive care unit in a tertiary care hospital from May-August 2009 were screened for an indication for enteral nutrition. Patients were followed up until leaving the intensive care unit or a maximum of 28 days. The gastrointestinal failure score was calculated daily by adding values of 0 if the enteral nutrition received was identical to the nutrition prescribed, 1 if the enteral nutrition received was at least 75% of that prescribed, 2 if the enteral nutrition received was between 50-75% of that prescribed, 3 if the enteral nutrition received was between 50-25% of that prescribed, and 4 if the enteral nutrition received was less than 25% of that prescribed. RESULTS: The mean, worst, and categorical gastrointestinal failure scores were associated with lower survival in these patients. Age, categorical gastrointestinal failure score, type of admission, need for mechanical ventilation, sequential organ failure assessment, and Acute Physiologic and Chronic Health Evaluation II scores were selected for analysis with binary regression. In both models, the categorical gastrointestinal failure score was related to mortality. CONCLUSION: The determination of the difference between prescribed and received enteral nutrition seemed to be a useful prognostic marker and is feasible to be incorporated into a gastrointestinal failure score

Instrumento para conhecimento dos hábitos posturais de escolares em sala de aula

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Bioerosion on late Quaternary Planktonic Foraminifera related to paleoproductivity in the western South Atlantic

Planktonic Foraminifera are widely used in paleoceanographic reconstructions, although studies of their trophic interactions are still rare, especially those focusing on predation. Drilling holes are the most frequent traces of bioerosion in foraminifer tests, but environmental factors that control bioerosion are not yet understood. To determine if paleoceanographic variables are associated with bioerosion rates in late Quaternary planktonic foraminifers of the western South Atlantic, geochemical and assemblage analyses were made on a 46 kyr record from a piston core. An age model was constructed based on 10 AMS 14C dates. To reconstruct the paleoproductivity, δ13C, benthic/planktonic foraminifer and the relative abundances of Globigerina bulloides and Globigerinoides ruber (high and low productivity, respectively) were used. Bioeroded tests were counted and found in 21 of the 25 identified species, with frequencies ranging from 8.84% to 16.7%. Bioerosion was different in two groups identified by cluster analysis, with a higher intensity during glacial times, showing a strong correlation with paleoceanographic fluctuations. Paleoproductivity estimates and bioerosion rates show a significant correlation, suggesting that bioerosion is more frequent in eutrophic environments and more inhibited in oligotrophic conditions. However, even with a strong correlation between bioerosion and productivity, there is also a negative correlation with sea surface temperature in the study area. Since conditions that promote higher productivity are accompanied by a decrease in surface temperature, the precise distinction between the influence of both variables is hampered. Further research will allow us to explore the potential of planktonic foraminiferal bioerosion as a tool in paleoceanographic studies

Anti-NMDA Receptor Autoantibody Is an Independent Predictor of Hospital Mortality but Not Brain Dysfunction in Septic Patients

The presence of autoantibodies against neuronal cell surface or synaptic proteins and their relationship to autoimmune encephalitis have recently been characterized. These autoantibodies have been also reported in other pathologic conditions; however, their role during sepsis is not known. This study detected the presence of autoantibodies against neuronal cell surface or synaptic proteins in the serum of septic patients and determined their relationship to the occurrence of brain dysfunction and mortality. This prospective, observational cohort study was performed in four Brazilian intensive care units (ICUs). Sixty patients with community-acquired severe sepsis or septic shock admitted to the ICU were included. Blood samples were collected from patients within 24 h of ICU admission. Antibodies to six neuronal proteins were assessed, including glutamate receptors (types NMDA, AMPA1, and AMPA2); voltage-gated potassium channel complex (VGKC) proteins, leucine-rich glioma-inactivated protein 1 (LGI1), and contactin-associated protein-2 (Caspr2), as well as the GABAB1 receptor. There was no independent association between any of the measured autoantibodies and the occurrence of brain dysfunction (delirium or coma). However, there was an independent and significant relationship between anti-NMDAR fluorescence intensity and hospital mortality. In conclusion, anti-NMDAR was independently associated with hospital mortality but none of the measured antibodies were associated with brain dysfunction in septic patients

Tratamento com N-acetilcisteína e deferroxiamina protege contra estresse oxidativo e aumenta sobrevida na sepse em ratos

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Synopsis of rubiaceae from the iguaçu national park, Paraná, Brazil

O Parque Nacional do Iguaçu representa o maior fragmento de Mata Atlântica de Interior do estado do Paraná. Sua vegetação é predominantemente de Floresta Estacional Semidecidual, nas áreas de Foz do Iguaçu e Capanema e uma transição desta com Floresta Ombrófila Mista, na Área de Céu Azul. Este trabalho teve por objetivo reconhecer os gêneros e espécies de Rubiaceae com ocorrência no Parque, através de coletas mensais de agosto de 2013 a julho de 2014, complementadas com coletas esporádicas de maio de 2018 a abril 2019. Foram encontradas 35 espécies, pertencentes a 19 gêneros. Os gêneros mais representativos foram Palicourea e Psychotria com cinco espécies, Galianthe, Manettia, Borreria com três, Geophila e Coccocypselum com duas e os demais gêneros com apenas uma espécie cada. As áreas com maiores riquezas de espécies foram Foz do Iguaçu, com 24, sendo quatro exclusivas desta área, seguidas de Céu Azul com 22 espécies, das quais oito são exclusivas. Das 35 espécies encontradas sete ocorrem em todas as áreas e em ambas as formações florestais, sete ocorrem só na área de Floresta Ombrófila Mista e 20 ocorrem somente na Floresta Estacional Semidecidual. Destacam-se ainda Borreria orientalis por ter uma distribuição restrita no Brasil, apenas no Paraná e Manettia tweedieana por ser considerada “Em Perigo” de extinção.Iguaçu National Park represents the largest fragment of Inland Atlantic Rainforest of Paraná state. The vegetation is predominantly seasonal semideciduous forest, in the areas of Foz do Iguaçu and Capanema and a transition of this with Araucaria forest, in the Céu Azul area. This work aimed to recognize the genera and species of Rubiaceae occurring in the Park, through monthly collections from August 2013 to July 2014, supplemented with sporadic collections from May 2018 to April 2019. Thirty-five species were recorded, belonging to 19 genera. The most representative genera were Palicourea and Psychotria with five species, Galianthe, Manettia, Borreria with three, Geophila and Coccocypselum with two, and the other genera with only one species each. The areas with the major species richness were Foz do Iguaçu, with 24, of which four are exclusive to this area, followed by Céu Azul with 22 species, of which eight are exclusive. Of the 35 species recorded, seven occur in all areas and in both forest formations, seven occur only in the Araucaria forest area, and 20 occur only in the seasonal semideciduous forest. Borreria orientalis is highlighted due to its restricted distribution in Brazil, occurring only in Paraná, and Manettia tweedieana is considered endangered.Fil: Ritter Rauber, Cristiane. Universidade Estadual Do Oeste Do Pará; BrasilFil: Livia Toderke, Marlene. Universidade Estadual Do Oeste Do Pará; BrasilFil: da Silva Zini, Annielly. Universidade Estadual Do Oeste Do Pará; BrasilFil: Pires Lima, Laura Cristina. Universidade Federal da Integração Latino Americana; BrasilFil: Galeazzi Caxambu, Marcelo. Universidade Tecnológica Federal do Paraná; BrasilFil: Salas, Roberto Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Botánica del Nordeste. Universidad Nacional del Nordeste. Facultad de Ciencias Agrarias. Instituto de Botánica del Nordeste; ArgentinaFil: Cabral, Elsa Leonor. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Botánica del Nordeste. Universidad Nacional del Nordeste. Facultad de Ciencias Agrarias. Instituto de Botánica del Nordeste; ArgentinaFil: Godinho Temponi, Lívia. Universidade Estadual Do Oeste Do Pará; Brasi

The validity and reliability of the Portuguese versions of three tools used to diagnose delirium in critically ill patients

OBJECTIVES: The objectives of this study are to compare the sensitivity and specificity of three diagnostic tools for delirium (the Intensive Care Delirium Screening Checklist, the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet) in a mixed population of critically ill patients, and to validate the Brazilian Portuguese Confusion Assessment Method for Intensive Care Units. METHODS: The study was conducted in four intensive care units in Brazil. Patients were screened for delirium by a psychiatrist or neurologist using the Diagnostic and Statistical Manual of Mental Disorders. Patients were subsequently screened by an intensivist using Portuguese translations of the three tools. RESULTS: One hundred and nineteen patients were evaluated and 38.6% were diagnosed with delirium by the reference rater. The Confusion Assessment Method for Intensive Care Units had a sensitivity of 72.5% and a specificity of 96.2%; the Confusion Assessment Method for Intensive Care Units Flowsheet had a sensitivity of 72.5% and a specificity of 96.2%; the Intensive Care Delirium Screening Checklist had a sensitivity of 96.0% and a specificity of 72.4%. There was strong agreement between the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet (kappa coefficient = 0.96) CONCLUSION: All three instruments are effective diagnostic tools in critically ill intensive care unit patients. In addition, the Brazilian Portuguese version of the Confusion Assessment Method for Intensive Care Units is a valid and reliable instrument for the assessment of delirium among critically ill patients