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

Impact of Subsyndromal Delirium Occurrence and Its Trajectory during ICU Stay

Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Publisher Copyright: © 2022 by the authors.Despite recent advances in the field, the association between subsyndromal delirium (SSD) in the ICU and poor outcomes is not entirely clear. We performed a retrospective multicentric observational study analyzing mental status during the first 72 h of ICU stay. Of the 681 patients included, SSD occurred in 22.7%. Considering the worst cognitive assessment during the first 72 h, 233 (34%) patients had normal mental status, 124 (18%) patients had SSD and 324 (48%) patients had delirium or coma. SSD was not independently associated with an increased risk of death when compared with normal mental status (OR 95%IC 1.0 vs. 1.35 [0.73–1.49], p = 0.340), but was associated with a longer ICU LOS (7.0 (4–12) vs. 4 (3–8) days, p 23 points. Our findings support the association of SSD with increased ICU LOS, but not with ICU mortality. Monitoring the trajectory of SSD early at ICU admission can help to identify patients with increased risk of conversion from SSD to delirium or coma.publishersversionpublishe

Results from a Cohort Observational Study

Purpose: COVID-19 presents complex pathophysiology, and evidence collected points towards an intricate interaction between viral-dependent and individual immunological mechanisms. Identifying phenotypes through clinical and biological markers may provide a better understanding of the subjacent mechanisms and an early patient-tailored characterization of illness severity. Methods: A multicenter prospective cohort study was performed in 5 hospitals in Portugal and Brazil for one year between 2020–2021. All adult patients with an Intensive Care Unit admission with SARS-CoV-2 pneumonia were eligible. COVID-19 was diagnosed using clinical and radiologic criteria with a SARS-CoV-2 positive RT-PCR test. A two-step hierarchical cluster analysis was made using several class-defining variables. Results: 814 patients were included. The cluster analysis revealed a three-class model, allowing for the definition of three distinct COVID-19 phenotypes: 407 patients in phenotype A, 244 patients in phenotype B, and 163 patients in phenotype C. Patients included in phenotype A were significantly older, with higher baseline inflammatory biomarkers profile, and a significantly higher requirement of organ support and mortality rate. Phenotypes B and C demonstrated some overlapping clinical characteristics but different outcomes. Phenotype C patients presented a lower mortality rate, with consistently lower C-reactive protein, but higher procalcitonin and interleukin-6 serum levels, describing an immunological profile significantly different from phenotype B. Conclusions: Severe COVID-19 patients exhibit three different clinical phenotypes with distinct profiles and outcomes. Their identification could have an impact on patients’ care, justifying different therapy responses and inconsistencies identified across different randomized control trial results.publishersversionpublishe

Grau de incapacidade, níveis de dor, força muscular e função eletromiográfica em portadores de hanseníase com lesão do nervo fibular comum

INTRODUCTION: This study evaluated the degree of disability, pain levels, muscle strength, and electromyographic function (RMS) in individuals with leprosy. METHODS: We assessed 29 individuals with leprosy showing common peroneal nerve damage and grade 1 or 2 disability who were referred for physiotherapeutic treatment, as well as a control group of 19 healthy participants without leprosy. All subjects underwent analyses of degree of disability, electromyographic tests, voluntary muscle force, and the Visual Analog Pain Scale. RESULTS: McNemar's test found higher levels of grade 2 of disability (Δ = 75.9%; p = 0.0001) among individuals with leprosy. The Mann-Whitney test showed greater pain levels (Δ = 5.0; p = 0.0001) in patients with leprosy who had less extension strength in the right and left extensor hallucis longus muscles (Δ = 1.28, p = 0.0001; Δ = 1.55, p = 0.0001, respectively) and dorsiflexion of the right and left feet (Δ = 1.24, p = 0.0001; Δ = 1.45, p = 0.0001, respectively) than control subjects. The Kruskal-Wallis test showed that the RMS score for dorsiflexion of the right (Δ = 181.66 m·s-2, p = 0.001) and left (Δ = 102.57m·s-2, p = 0.002) feet was lower in patients with leprosy than in control subjects, but intragroup comparisons showed no difference. CONCLUSIONS: Leprosy had a negative influence on all of the study variables, indicating the need for immediate physiotherapeutic intervention in individuals with leprosy. This investigation opens perspectives for future studies that analyze leprosy treatment with physical therapeutic intervention.INTRODUÇÃO: O objetivo do estudo foi avaliar o grau de incapacidade, níveis de dor, força muscular e a função eletromiográfica (RMS) em indivíduos portadores de hanseníase. MÉTODOS: A amostra foi composta de um grupo de 29 sujeitos portadores de hanseníase, apresentando lesão do nervo fibular comum e grau 1 ou 2 de incapacidade, com indicação ao tratamento fisioterapêutico, e um grupo controle de 19 indivíduos saudáveis, sem hanseníase. Os sujeitos foram submetidos à análise do grau de incapacidade, testes de eletromiografia, de força muscular voluntária e da Escala Visual Analógica (EVA) para a dor. RESULTADOS: O teste de McNemar mostrou maior prevalência do grau dois de incapacidade (Δ=75,9%; p=0,0001) entre os indivíduos com hanseníase. O teste de Mann-Whitney revelou maiores níveis de dor (Δ=5,0; p=0,0001) nos pacientes com hanseníase apresentando menores níveis de força muscular da extensão do hálux direito e esquerdo (Δ=1,28, p=0,0001; Δ=1,55, p=0,0001) e flexão dorsal do pé direito e esquerdo (Δ=1,24, p=0,0001; Δ=1,45, p=0,0001) do que os indivíduos sem hanseníase. O teste de Kruskal-Wallis revelou que os valores do RMS da flexão dorsal dos pés direito (Δ=181,66m.s-², p=0,001) e esquerdo (Δ=102,57m.s-2, p=0,002) apresentaram menores valores que o grupo controle em ambos os lados, mas as comparações intragrupos não mostraram diferenças. CONCLUSÕES: Conclui-se que a hanseníase altera todas as variáveis analisadas na pesquisa, indicando a necessidade de intervenção fisioterapêutica imediata nos sujeitos com Hanseníase. Esta investigação abre perspectivas de futuras pesquisas que analisem o tratamento da hanseníase com intervenção fisioterapêutica.Universidade Estadual do Piauí Centro de Ciências da SaúdeUniversidade Federal do Estado do Rio de Janeiro Laboratório de Biociências da Motricidade HumanaHospital Getúlio Vargas Clínica DermatológicaEscola de Educação Física do Exército BrasileiroFundação Oswaldo Cruz, Rio de Janeiro Laboratório de Doenças ParasitáriasUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade do Oeste de Santa Catarina Laboratório de Aspectos Moleculares Associados a Doenças GenéticasUniversidade Federal do Rio Grande do SulUniversidade Federal do Estado do Rio de JaneiroUNIFESP, EPMSciEL

A CEGUEIRA BOTÂNICA: QUAL A SUA RELAÇÃO AO ENSINO DA BIOLOGIA VEGETAL?

Introduction: Plants form the basis of habitats and are therefore extremely important. Despite this, most people can not identify them in their natural environment, this effect is given the name of botanical blindness. Objective: To identify in the scientific literature how botanical blindness is related to the teaching of plant biology. Material and methods: This is a literature narrative review study, based on articles indexed to the Scientific Electronic Library Online, CAPES and Google Scholar data platforms. The search strings were used: "Botanical Blindness" and "Botany Teaching", interconnected by the Boleyn operator "AND" for the search for articles. Inclusion criteria were used: works with complete structuring, available free of charge, written in Portuguese or English, between 2000 and 2022. Results and discussion: The teaching-learning process of botany that happens mainly by traditional teaching methods, established in the memorization and lack of contextualization and participation of students can generate aversion and disinterest in the contents of botany, contributing to the strengthening of botanical blindness. An active, contextualized teaching, which values the active participation of students, can bring a mitigation of this phenomenon. Final considerations: Active teaching methodologies are presented as a way to overcome what is currently understood by botanical blindness.Introducción: Las plantas forman la base de los hábitats y, por lo tanto, son extremadamente importantes. A pesar de esto, la mayoría de las personas no pueden identificarlos en su entorno natural, a este efecto se le da el nombre de ceguera botánica. Objetivo: Identificar en la literatura científica cómo la ceguera botánica se relaciona con la enseñanza de la biología vegetal. Material y métodos: Se trata de un estudio de revisión narrativa bibliográfica, basado en artículos indexados a las plataformas de datos Scientific Electronic Library Online, CAPES y Google Scholar. Se utilizaron las cadenas de búsqueda: "Ceguera botánica" y "Enseñanza de la botánica", interconectadas por el operador de Bolena "AND" para la búsqueda de artículos. Se utilizaron criterios de inclusión: obras con estructuración completa, disponibles gratuitamente, escritas en portugués o inglés, entre 2000 y 2022. Resultados y discusión: El proceso de enseñanza-aprendizaje de la botánica que ocurre principalmente por métodos tradicionales de enseñanza, establecidos en la memorización y falta de contextualización y participación de los estudiantes puede generar aversión y desinterés en los contenidos de la botánica, contribuyendo al fortalecimiento de la ceguera botánica. Una enseñanza activa, contextualizada, que valore la participación activa de los estudiantes, puede traer una mitigación de este fenómeno. Consideraciones finales: Las metodologías de enseñanza activa se presentan como una forma de superar lo que actualmente se entiende por ceguera botánica.As plantas constituem a base dos habitats e por isso são de extrema importância. Apesar disso, a maioria das pessoas não consegue identificá-las em seu ambiente natural, a este efeito dá-se o nome de cegueira botânica. Objetivo: Identificar na literatura científica como a cegueira botânica se relaciona com o ensino da biologia vegetal. Material e métodos: Trata-se de um estudo de revisão narrativa de literatura, fundamentada em artigos indexados às plataformas de dados Scientific Electronic Library Online, Periódicos CAPES e Google Acadêmico. Utilizou-se as strings de busca: "Cegueira Botânica" e "Ensino de Botânica", interconectadas pelo operador boleano "AND" para a busca dos artigos. Critérios de inclusão foram utilizados: trabalhos com estruturação completa, disponíveis de forma gratuita, escritos em português ou inglês, entre 2000 e 2022. Resultados e discussão: O processo de ensino-aprendizagem de botânica que acontece principalmente pelos métodos de ensino tradicionais, firmados na memorização e na falta de contextualização e de participação dos estudantes pode gerar aversão e desinteresse quanto aos conteúdos da botânica, contribuindo para o fortalecimento da cegueira botânica. Um ensino ativo, contextualizado, que preza pela participação ativa dos estudantes, pode trazer uma mitigação deste fenômeno. Considerações finais: As metodologias ativas de ensino se apresentam como uma maneira de superar o que é atualmente compreendido por cegueira botânica.Introdução: As plantas constituem a base dos habitats e por isso são de extrema importância. Apesar disso, a maioria das pessoas não consegue identificá-las em seu ambiente natural, a este efeito dá-se o nome de cegueira botânica. Objetivo: Identificar na literatura científica como a cegueira botânica se relaciona com o ensino da biologia vegetal. Material e métodos: Trata-se de um estudo de revisão narrativa de literatura, fundamentada em artigos indexados às plataformas de dados Scientific Electronic Library Online, Periódicos CAPES e Google Acadêmico. Utilizou-se as strings de busca: "Cegueira Botânica" e "Ensino de Botânica", interconectadas pelo operador boleano "AND" para a busca dos artigos. Critérios de inclusão foram utilizados: trabalhos com estruturação completa, disponíveis de forma gratuita, escritos em português ou inglês, entre 2000 e 2022. Resultados e discussão: O processo de ensino-aprendizagem de botânica que acontece principalmente pelos métodos de ensino tradicionais, firmados na memorização e na falta de contextualização e de participação dos estudantes pode gerar aversão e desinteresse quanto aos conteúdos da botânica, contribuindo para o fortalecimento da cegueira botânica. Um ensino ativo, contextualizado, que preza pela participação ativa dos estudantes, pode trazer uma mitigação deste fenômeno. Considerações finais: As metodologias ativas de ensino se apresentam como uma maneira de superar o que é atualmente compreendido por cegueira botânica

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

Composição química do óleo essencial de Varronia dardani (Taroda) J.S. Mill e sua atividade antibiofilme / Chemical composition of Varronia dardani (Taroda) J.S. Mill essential oil and its antibiofilm activity

O gênero Varronia pertence à família Cordiaceae. Alguns óleos essenciais de espécies deste gênero são identificados na literatura com atividades anti-inflamatórias. Esta espécie não tem relatos na medicina popular. O óleo essencial das partes aéreas da V. dardani foi extraído por hidrodistilação e usado por cromatografia gasosa acoplada à espectrometria de massa. Uma composição química de óleo de V. dardani foi de 97,2% de monoterpenos e sesquiterpenos. O ?-cadineno (8,71%), timol (7,43%), carvacrol (5,92%), ?-cadineno (5,66%), p-cimeno (5,25%) e ?-cadinol (5,20%) foram os constituintes majoritários.Uma atividade antimicrobiana foi investigada pelo método de microdiluição e foi testada com inibição da formação de biofilme, utilizando microorganismos de interesse em odontologia. O óleo essencial inibido do crescimento de Enterococcus faecalis e Streptococcus salivarius . Os resultados indicaram que uma espécie contém sua composição química com potencial antimicrobiano, necessitando assim de estudos complementares, utilizando uma pesquisa de uma nova terapia para infecções dentárias que usa uma determinada citada

Dapagliflozin and Kidney Outcomes in Hospitalized Patients with COVID-19 Infection:An Analysis of the DARE-19 Randomized Controlled Trial

Background and objectives: Patients who were hospitalized with coronavirus disease 2019 (COVID-19) infection are at high risk of AKI and KRT, especially in the presence of CKD. The Dapagliflozin in Respiratory Failure in Patients with COVID-19 (DARE-19) trial showed that in patients hospitalized with COVID-19, treatment with dapagliflozin versus placebo resulted in numerically fewer participants who experienced organ failure or death, although these differences were not statistically significant. We performed a secondary analysis of the DARE-19 trial to determine the efficacy and safety of dapagliflozin on kidney outcomes in the overall population and in prespecified subgroups of participants defined by baseline eGFR. Design, setting, participants, & measurements: The DARE-19 trial randomized 1250 patients who were hospitalized (231 [18%] had eGFR <60 ml/min per 1.73 m2) with COVID-19 and cardiometabolic risk factors to dapagliflozin or placebo. Dual primary outcomes (time to new or worsened organ dysfunction or death, and a hierarchical composite end point of recovery [change in clinical status by day 30]), and the key secondary kidney outcome (composite of AKI, KRT, or death), and safety were assessed in participants with baseline eGFR <60 and ≥60 ml/min per 1.73 m2. Results: The effect of dapagliflozin versus placebo on the primary prevention outcome (hazard ratio, 0.80; 95% confidence interval, 0.58 to 1.10), primary recovery outcome (win ratio, 1.09; 95% confidence interval, 0.97 to 1.22), and the composite kidney outcome (hazard ratio, 0.74; 95% confidence interval, 0.50 to 1.07) were consistent across eGFR subgroups (P for interaction: 0.98, 0.67, and 0.44, respectively). The effects of dapagliflozin on AKI were also similar in participants with eGFR <60 ml/min per 1.73 m2 (hazard ratio, 0.71; 95% confidence interval, 0.29 to 1.77) and ≥60 ml/min per 1.73 m2 (hazard ratio, 0.69; 95% confidence interval, 0.37 to 1.29). Dapagliflozin was well tolerated in participants with eGFR <60 and ≥60 ml/min per 1.73 m2. Conclusions: The effects of dapagliflozin on primary and secondary outcomes in hospitalized participants with COVID-19 were consistent in those with eGFR below/above 60 ml/min per 1.73 m2. Dapagliflozin was well tolerated and did not increase the risk of AKI in participants with eGFR below or above 60 ml/min per 1.73 m2