C-reactive protein in critically ill cancer patients with sepsis: influence of neutropenia

Introduction: Several biomarkers have been studied in febrile neutropenia. Our aim was to assess C-reactive protein (CRP) concentration in septic critically ill cancer patients and to compare those with and without neutropenia. Methods: A secondary analysis of a matched case-control study conducted at an oncologic medical-surgical intensive care unit (ICU) was performed, segregating patients with severe sepsis/septic shock. The impact of neutropenia on CRP concentrations at admission and during the first week of ICU stay was assessed. Results: A total of 154 critically ill septic cancer patients, 86 with neutropenia and 68 without, were included in the present study. At ICU admission, the CRP concentration of neutropenic patients was significantly higher than in non-neutropenic patients, 25.9 +/- 11.2 mg/dL vs. 19.7 +/- 11.4 mg/dL (P = 0.009). Among neutropenic patients, CRP concentrations at ICU admission were not influenced by the severity of neutropenia (= 100/mm(3) neutrophils), 25.1 +/- 11.6 mg/dL vs. 26.9 +/- 10.9 mg/dL (P = 0.527). Time dependent analysis of CRP from Day 1 to Day 7 of antibiotic therapy showed an almost parallel decrease in both groups (P = 0.335), though CRP of neutropenic patients was, on average, always higher in comparison to that of non-neutropenic patients. Conclusions: In septic critically ill cancer patients CRP concentrations are more elevated in those with neutropenia. However, the CRP course seems to be independent from the presence or absence of neutropenia.publishersversionpublishe

Evaluation of antibacterial, antifungal and modulatory activity of methanol and ethanol extracts of Padina sanctae-crucis

Background: Multi-resistant microorganisms such as Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Candida tropicalis e Candida krusei are the main causes of microbial infections. Padina sanctae-crucis is a seaweed often used to check the contamination of ecosystems by materials such as heavy metals, but studies of the antimicrobial activity of the same seaweed were not found.Methods: The tests for the minimum inhibitory concentration and   modulation of microbial resistance, with the use of ethanolic and  methanolic extracts of Padina Sanctae-cruces combined with drugs of the class of aminoglycosides and antifungal were used to evaluate the activity against the cited microorganisms.Results: Was observed a modulation of antibiotic activity between the natural products and the E. coli and S. aureus strains, indicating a synergism and antagonism respectively.Conclusions: The results showed a moderate modulatory effect against some microorganisms studied.Keywords: multi-resistant microorganisms, modulation, Padina Sanctae-crucis, antimicrobial activity

Effect Of Photoinitiator Concentration On Marginal And Internal Adaptation Of Experimental Composite Blends Photocured By Modulated Methods.

The aim of this study was to evaluate the influence of photoinitiator concentration on marginal and internal adaptation of composites photocured by modulated methods. Composites based on BisGMA/triethylene glycol dimethacrylate and 65 wt% of filler were prepared with different concentrations of camphorquinone/amine (C1-0.5%, C2-1%, C3-1.5%). Cavities were prepared (3 mm × 3 mm × 2 mm) on the buccal surface of 120 bovine incisors and the adhesive system Adper Single Bond 2 was applied following manufactures instruction. Specimens were then distributed according to type of composite (C1, C2, C3) and photoactivation method (high-intensity - 750 mW/cm(2) for 40 s; low intensity - 150 mW/cm(2) for 200 s; soft-start - 150 mW/cm(2) for 10 s + 750 mW/cm(2) for 38 s; pulse-delay - 150 mW/cm(2) for 10 s + 3 min dark + 750 mW/cm(2) for 38 s). Superficial and internal margins were analyzed by scanning electron microscopy, using the epoxy replica technique. The length of gaps was expressed as a percentage of the total length of the margins. Data were submitted to two-way analysis of variance and Tukey's test (α =0.05). Modulated curing methods did not influence gap formation regarding both superficial and internal adaptation. The composite with the lower initiator concentration (C1) presented higher gap formation when compared with those with higher concentrations (C2 and C3). Modulated photoactivation methods did not reduce gap formation for the experimental composite restorations evaluated. However, higher photoinitiator concentrations promote better marginal seal.7S1-

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

Introduction: Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. the aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV).Methods: A secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality.Results: A total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P = 0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P=0.001) despite similar PaO2/FiO(2) ratios and acute respiratory distress syndrome (ARDS) severity. in a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% Cl, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; Cl 95%, 1.00 to 1.04), severe ARDS (OR 1.44; Cl 95%, 1.09 to 1.91) and deep sedation (OR 2.36; Cl 9596, 1.31 to 4.25) were independently associated with increased hospital mortality.Conclusions: Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.Research and Education Institute from Hospital Sirio-Libanes, São PauloD'Or Institute for Research and Education, Rio de Janeiro, BrazilBrazilian Research in Intensive Care NetworkHosp Copa DOr, BR-22031010 Rio de Janeiro, BrazilHosp Sirio Libanes, Res & Educ Inst, BR-01308060 São Paulo, BrazilUniv São Paulo, Fac Med, Hosp Clin, ICU,Emergency Med Dept, BR-05403000 São Paulo, BrazilHosp Sao Camilo Pompeia, ICU, BR-05022000 São Paulo, BrazilCEPETI, BR-82530200 Curitiba, Parana, BrazilHosp Canc I, Inst Nacl Canc, ICU, BR-20230130 Rio de Janeiro, BrazilPasteur Hosp, ICU, BR-20735040 Rio de Janeiro, BrazilIrmandade Santa Casa Misericordia Porto Alegre, RIPIMI, BR-90020090 Porto Alegre, RS, BrazilVitoria Apart Hosp, ICU, BR-29161900 Serra, ES, BrazilHosp Mater Dei, ICU, BR-30140093 Belo Horizonte, MG, BrazilHosp Santa Luzia, ICU, BR-70390902 Brasilia, DF, BrazilHosp Sao Luiz, ICU, BR-04544000 São Paulo, BrazilUniversidade Federal de São Paulo, Anesthesiol Pain & Intens Care Dept, ICU, BR-04024900 São Paulo, BrazilHosp Sao Jose Criciuma, ICU, BR-88801250 Criciuma, BrazilUDI Hosp, ICU, BR-65076820 Sao Luis, BrazilUniv São Paulo, Univ Hosp, ICU, BR-05508000 São Paulo, BrazilUniv São Paulo, Fac Med, Hosp Clin, ICU,Surg Emergency Dept, BR-05403000 São Paulo, BrazilIDOR DOr Inst Res & Educ, BR-22281100 Rio de Janeiro, BrazilInst Nacl Canc, Postgrad Program, BR-20230130 Rio de Janeiro, BrazilUniversidade Federal de São Paulo, Anesthesiol Pain & Intens Care Dept, ICU, BR-04024900 São Paulo, BrazilWeb of Scienc

Avaliação da lordose lombar e sua relação com a dor lombopélvica em gestantes

O objetivo deste trabalho foi avaliar a magnitude da lordose lombar, sua influência na dor lombopélvica e a qualidade de vida em gestantes. Para tal, foi realizado um estudo com 20 mulheres não gestantes (C) e 13 gestantes ao longo dos trimestres gestacionais (G1, G2 e G3). Todas as mulheres foram submetidas à avaliação inicial para registro dos dados pessoais, hábitos de vida, antecedentes pessoais, uso de medicamentos, história ginecológica e obstétrica. Posteriormente, as voluntárias do grupo controle foram avaliadas uma vez e as gestantes foram avaliadas em três momentos distintos, no 10, 20 e 30 trimestres gestacionais. A avaliação do grau de lordose lombar foi realizada por meio de técnica fotogramétrica; a avaliação de locais de dor, o tipo de dor e sua intensidade foram feitas por meio do Questionário McGill de dor; e a avaliação da qualidade de vida foi feita pelo Questionário WHOQOL-bref. Neste trabalho, não foi possível observar padrão de alteração da curvatura lombar no decorrer da gestação. Também não foi observada relação entre a curvatura lombar e a dor lombopélvica relacionada à gestação.The purpose of this study was to evaluate the magnitude of lumbar lordosis, its influence on lumbopelvic pain and quality of life in pregnant women. To this end, a study was done with 20 non-pregnant women (C) and 13 pregnant women during the trimesters of pregnancy (G1, G2 and G3). All women underwent initial assessment for registration of personal data, lifestyle, personal history, medications, gynecological and obstetric history. Later, the volunteers in the control group were evaluated once and pregnant women were evaluated at three different times, the first, second and third trimesters of pregnancy. The evaluation of the degree of lumbar lordosis was performed by a photogrammetric technique. The assessment of points/places of pain, the kind of pain and its intensity were made by McGill Pain Questionnaire, and the quality of life assessment was made by WHOQOL-bref. In this study, it was not possible to observe a pattern of change in lumbar curvature during pregnancy. There was also no relationship between lumbar curvature and lumbopelvic pain related to pregnancy

Continuing education in neurology through the internet

The internet technology represents a new valuable resource for continuing education in neurology. The Committee of Medical Education of the Brazilian Academy of Neurology prepared a guideline of selected sites in neurology, making the use of Internet more productive, combining learning with entertainment.59114214