Mortality of Patients with Hematological Malignancy after Admission to the Intensive Care Unit

Background: The admission of patients with malignancies to an intensive care unit (ICU) still remains a matter of substantial controversy. The identification of factors that potentially influence the patient outcome can help ICU professionals make appropriate decisions. Patients and Methods: 90 adult patients with hematological malignancy (leukemia 47.8%, high-grade lymphoma 50%) admitted to the ICU were analyzed retrospectively in this single-center study considering numerous variables with regard to their influence on ICU and day-100 mortality. Results: The median simplified acute physiology score (SAPS) II at ICU admission was 55 (ICU survivors 47 vs. 60.5 for non-survivors). The overall ICU mortality rate was 45.6%. With multivariate regression analysis, patients admitted with sepsis and acute respiratory failure had a significantly increased ICU mortality (sepsis odds ratio (OR) 9.12, 95% confidence interval (CI) 1.1-99.7, p = 0.04; respiratory failure OR 13.72, 95% CI 1.39-136.15, p = 0.025). Additional factors associated with an increased mortality were: high doses of catecholamines (ICU: OR 7.37, p = 0.005; day 100: hazard ratio (HR) 2.96, p < 0.0001), renal replacement therapy (day 100: HR 1.93, p = 0.026), and high SAPS II (ICU: HR 1.05, p = 0.038; day 100: HR 1.2, p = 0.027). Conclusion: The decision for or against ICU admission of patients with hematological diseases should become increasingly independent of the underlying malignant disease

Somatic and cognitive-affective depressive symptoms among patients with heart disease: differences by sex and age

OBJECTIVE: this study investigated the association of somatic and cognitive-affective symptoms with sex and age, among patients hospitalized with heart disease. METHOD: this study was a secondary analysis of two previous observational studies totaling 531 patients with heart disease, hospitalized from 2005 to 2011 in two public hospitals in Ribeirão Preto, state of São Paulo, Brazil. Somatic and cognitive-affective symptoms were assessed using the subscales of the Beck Depression Inventory - I (BDI-I). RESULTS: of 531 participants, 62.7% were male, with a mean age 57.3 years (SD= 13.0) for males and 56.2 years (SD= 12.1) for females. Analyses of variance showed an effect of sex (p<0.001 for somatic and p=0.005 for cognitive-affective symptoms), but no effect of age. Women presented with higher mean values than men in both BDI-I subscales: 7.1 (4.5) vs. 5.4 (4.3) for somatic, and 8.3 (7.9) vs. 6.7 (7.2) for cognitive-affective symptoms. There were no differences by age for somatic (p=0.84) or cognitive-affective symptoms (p=0.84). CONCLUSION: women hospitalized with heart disease had more somatic and cognitive-affective symptoms than men. We found no association of somatic and cognitive-affective symptoms with age. Future research for these patients could reveal whether these differences according to sex continue throughout the rehabilitation process

Influência do intervalo de tempo entre as sessões de alongamento no ganho de flexibilidade dos isquiotibiais Influence of the time interval between stretching sessions on increased hamstring flexibility

CONTEXTO: A otimização do treino de flexibilidade está relacionada com o uso de parâmetros adequados de alongamento. Entretanto, o intervalo de tempo adequado entre as sessões de alongamento tem sido pouco investigado. OBJETIVO: Verificar se a variação no intervalo de tempo entre sessões de alongamento influencia no ganho de flexibilidade. MÉTODOS: 28 mulheres, com idade de 22,5 ± 1,8 anos, foram distribuídas aleatoriamente em três grupos. Aplicaram-se 10 sessões de alongamento nos isquiotibiais do membro direito. O grupo 0X (n = 8) foi o controle e não recebeu alongamento. O grupo 3X (n = 10) alongou três vezes por semana (intervalo de 48 horas) e o grupo 5X (n = 10), cinco vezes (intervalo de 24 horas). Aplicaram-se 10 sessões de alongamento (sustentar-relaxar) nos isquiotibiais direitos. As medidas foram tomadas por análise fotométrica no programa AutoCad® 2000. A análise estatística foi realizada com ANOVA e teste post hoc de Newman-Keuls adotando um p-valor referencial de 0,05. RESULTADOS: Após 10 sessões, identificou-se aumento da flexibilidade nos grupos experimentais, porém sem diferença entre estes. O grupo 3X aumentou significativamente a partir do 10º dia do programa (quinta sessão) e o grupo 5X, a partir do terceiro (terceira sessão). CONCLUSÕES: O alongamento aumenta a flexibilidade dos isquiotibiais, independente do tempo entre as sessões (24 ou 48 horas); e a variável tempo não influencia o ganho de flexibilidade total. Porém, com cinco sessões semanais, ganha-se flexibilidade mais rapidamente. Isso sugere que o ganho de flexibilidade é sessão-dependente.<br>CONTEXT: The optimization of flexibility training is related to the use of ideal stretching parameters. However, the time interval between sessions has been little investigated. OBJECTIVE: To verify if the variation in time interval between stretching sessions influences in flexibility gain. METHODOLOGY: Twenty-eight women, average age of 22.5 ± 1.8 years, were randomly distributed into three groups. Group 0X was the control and performed no stretching. Group 3X (n = 10) took part in three sessions per week (interval = 48 hours) and group 5X (n = 10) in five times (interval = 24 hours). Ten stretching sessions were applied (hold-relax) to the right hamstring. The measurement of active knee extension was performed using photometric analyses on AutoCAD® 2000 software. Statistical analysis was carried out with ANOVA and Newman-Keuls post hoc test for a significance level of p < 0.05. RESULTS: After 10 sessions, increased flexibility was identified in the experimental groups (p < 0.01), but with no difference between them. Group 3X significantly increased flexibility from the tenth day of the program (fifth session) and group 5X from the third day (third session). CONCLUSIONS: Stretching increases hamstring flexibility, regardless of the time between sessions (24 or 48 hours). Moreover, the interval between the sessions does not influence total flexibility gain. However, with five weekly stretching sessions, flexibility increases more rapidly than it does with three, suggesting that flexibility gain is session-dependent