RESUMO
OBJECTIVE: The main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV). DESIGN: A retrospective subanalysis of a prospective observational study conducted in 1998, 2004, 2010 and 2016 was carried out. SETTING: Intensive Care Units (ICUs) in Mexico. PARTICIPANTS: Adult patients consecutively enrolled in the ICU during one month and who underwent IMV for more than 12hours or noninvasive mechanical ventilation for more than one hour. Follow-up was performed up to a maximum of 28 days after inclusion. INTERVENTIONS: None. PRINCIPAL VARIABLES OF INTEREST: Age, sex, severity upon admission as estimated by SAPS II, parameters of daily arterial blood gases, treatment and complication variables, date and status at discharge from the ICU and from hospital. RESULTS: A total of 959 patients were included in 81 ICUs. Tidal volume (vt) decreased significantly both in patients with acute respiratory distress syndrome (ARDS) criteria (estimated 8.5ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001) and in patients without ARDS (estimated 9ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001). The ventilatory protective strategy (defined as vt < 6ml/kg or < 8ml/kg and a plateau pressure < 30cmH2O) was: 19% in 1998, 44% in 2004, 58% in 2010 and 75% in 2016 (P<0.001). The adjusted mortality rate in ICU over the 4 periods was: in 2004, odds ratio (OR) 1.05 (95% confidence interval, 95%CI: 0.73-1.72; P=0.764); in 2010, OR 1.68 (95%CI: 1.13-2.48; P=0.009); in 2016, OR 0.85 (95%CI: 0.60-1.20; P=0.368). CONCLUSIONS: The clinical practice of IMV in Mexican ICUs has been modified over a period of 18 years. The most significant change is the ventilatory strategy based on low vt. These changes have not been associated with significant changes in mortality.
RESUMO
PURPOSE: The aim of this study is to analyze the agreement between the classifications based on morphology and diameter of vitreomacular traction (VMT) syndrome, as well as to correlate the morphological findings of VMT with specific maculopathies. METHODS: Fifty-three eyes with VMT syndrome were categorized into two classifications based on optical coherence tomography images: the VMT morphology (V- or J-shaped) and the diameter of adhesion (focal ≤ 1500 µm or broad>1500 µm). RESULTS: High correlation was seen between V-shaped and focal-VMT and between J-shaped and broad-VMT (kappa=0.850; P<0.001), except in four cases with broad adhesion despite the presence of a V-shaped pattern. These four cases had common characteristics to those with broad vitreal attachment regarding associated maculopathies and visual function. V-shaped VMT (n=29) and focal-VMT (n=25) led to tractional cystoid macular edema (CME; 79.31% and 84%, respectively) and macular hole (MH; 37.93% and 44%); J-shaped VMT (n=24) and broad-VMT (n=28) were associated with epiretinal membranes (ERMs; 91.66% and 92.85%, respectively) and diffuse retinal thickening (62.50% and 64.28%). The best-corrected visual acuity (BCVA) was not significantly different between the groups (BCVA logarithm of the minimum angle of resolution: V-shaped, 0.45; J-shaped, 0.46; P=0.816; and focal, 0.50; broad, 0.42; P=0.198). CONCLUSIONS: Although highly concordant, the classification based on the diameter of the adhesion and not on the classical adhesion morphology seemed to better reflect the specific macular changes. V-shaped and focal VMT led to tractional CME and MH, while J-shaped and broad VMT were associated with ERM and diffuse retinal thickening.
Assuntos
Oftalmopatias/classificação , Adesões Focais/classificação , Doenças Retinianas/classificação , Corpo Vítreo/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome , Tomografia de Coerência ÓpticaRESUMO
Introducción: la posibilidad de identificar pacientes HER2 positivo y poder ofrecerles una terapia específica ha cambiado el pronóstico y la evolución de las mismas, es por ello que la determinación de sobreexpresión de HER2 es una factor clave para la toma de decisiones en el tratamiento del cáncer de mama. Objetivo: recolectar datos locales de la incidencia de la sobreexpresión de HER2 en la población con cáncer de mama de reciente diagnóstico y datos de anatomía patológica y la relación de los mismos con la sobreexpresión de HER2. Materiales y método: estudio epidemiológico que recolecta datos de las fichas de anatomía patológica y de las historias clínicas de pacientes con cáncer de mama operadas entre agosto de 2006 y agosto de 2007. De las biopsias previamente realizadas de rutina en pacientes operadas, se tomó un extendido para la determinación de HER2 por inmunohistoquímica (IHQ) con un anticuerpo policlonal anti HER2 (Dako), recuperación antigénica en microondas, sistema de detección En Vision (Dako) y revelado con diaminobenzidina. Para interpretar los resultados se usó el score de ASCO/CAP. Resultados: ingresaron 342 pacientes, HER negativo, 285 pacientes (83%); dudoso, 19 pacientes (6%); y HER2 positivo, 38 pacientes (11%). La edad promedio fue de 63,7 años. Se compararon las características clínicas y anatomopatológicas de ambas poblaciones (Tabla I). Conclusiones: la incidencia de HER2 positivo fue inferior (11%) a las reportadas en otras series, probablemente influida por el tamaño de la muestra o por el estadio inicial de las pacientes.
Assuntos
Neoplasias da Mama , Estudos EpidemiológicosRESUMO
Introducción: la posibilidad de identificar pacientes HER2 positivo y poder ofrecerles una terapia específica ha cambiado el pronóstico y la evolución de las mismas, es por ello que la determinación de sobreexpresión de HER2 es una factor clave para la toma de decisiones en el tratamiento del cáncer de mama. Objetivo: recolectar datos locales de la incidencia de la sobreexpresión de HER2 en la población con cáncer de mama de reciente diagnóstico y datos de anatomía patológica y la relación de los mismos con la sobreexpresión de HER2. Materiales y método: estudio epidemiológico que recolecta datos de las fichas de anatomía patológica y de las historias clínicas de pacientes con cáncer de mama operadas entre agosto de 2006 y agosto de 2007. De las biopsias previamente realizadas de rutina en pacientes operadas, se tomó un extendido para la determinación de HER2 por inmunohistoquímica (IHQ) con un anticuerpo policlonal anti HER2 (Dako), recuperación antigénica en microondas, sistema de detección En Vision (Dako) y revelado con diaminobenzidina. Para interpretar los resultados se usó el score de ASCO/CAP. Resultados: ingresaron 342 pacientes, HER negativo, 285 pacientes (83%); dudoso, 19 pacientes (6%); y HER2 positivo, 38 pacientes (11%). La edad promedio fue de 63,7 años. Se compararon las características clínicas y anatomopatológicas de ambas poblaciones (Tabla I). Conclusiones: la incidencia de HER2 positivo fue inferior (11%) a las reportadas en otras series, probablemente influida por el tamaño de la muestra o por el estadio inicial de las pacientes.
Assuntos
Neoplasias da Mama , Estudos EpidemiológicosRESUMO
The fetal origins hypothesis states that nutritional deprivation in utero affects fetal development and contributes to the incidence of diseases associated with the metabolic syndrome in later life. This study investigated whether haemoglobin (Hb) A(1c), an indicator of blood glucose, varied among healthy male adolescents according to their fetal growth rate, in a middle-income setting. Participants were men aged 18 years, belonging to the 1982 Pelotas birth cohort. Complete data, including gestational age and Hb A(1c) at age 18 years, were available for 197 individuals. There was an inverse association between mean Hb A(1c) and birthweight for the gestational age, but not birthweight alone. The association remained significant after adjustment for family income and mother's education, as well as for body mass index at 18 years (P for trend=0.01 and 0.03, respectively).
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Peso ao Nascer/fisiologia , Retardo do Crescimento Fetal/fisiopatologia , Hemoglobinas Glicadas/análise , Nível de Saúde , Recém-Nascido/crescimento & desenvolvimento , Recém-Nascido Pequeno para a Idade Gestacional , Adolescente , Brasil , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/sangue , Retardo do Crescimento Fetal/metabolismo , Idade Gestacional , Humanos , Lactente , Recém-Nascido/sangue , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Fatores de Risco , Fatores SocioeconômicosRESUMO
Six Holstein-Friesian heifers fitted with ruminal, duodenal, and ileal cannulas were used in a replicated 3x3 Latin square to study the effects of partial replacement [1:1 dry matter (DM) basis] of fresh winter oats (WO) by ground corn (C) or barley (B) on digestion and bacterial protein synthesis. Supplemented diets contained 24% starch, and all diets were fed indoors at 2.5% of body weight (DM basis). Ruminal and total tract digestibilities of organic matter and neutral detergent fiber were similar for all treatments. Ruminal and total tract starch digestibility was similar for C and B diets. Nitrogen intake was greater for WO than for supplemented diets. However, duodenal flows of nonammonia N and bacterial N did not differ among treatments. The efficiency of bacterial protein synthesis was similar for the three diets, suggesting that the fermentation of high quality fresh forage DM provided sufficient energy for the microorganisms in the rumen. Ruminal ammonia-N concentration was greater for WO than for supplemented diets, and for C than for B diet. Ruminal fluid pH and concentrations of total volatile fatty acid were not different among diets, but concentration of acetate was higher and that of propionate was lower for WO than for supplemented diets and for C than for B diet. Supplementation of WO with barley rather than with corn decreased C2:C3 ratio without affecting fiber digestion. Supplements increased N utilization relative to N intake but did not increase duodenal nonammonia N flow.
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Avena , Proteínas de Bactérias/biossíntese , Bovinos/fisiologia , Digestão , Hordeum , Zea mays , Amônia/metabolismo , Fenômenos Fisiológicos da Nutrição Animal , Animais , Dieta , Fibras na Dieta/administração & dosagem , Fibras na Dieta/metabolismo , Duodeno/fisiologia , Ácidos Graxos Voláteis/metabolismo , Feminino , Fermentação , Nitrogênio/administração & dosagem , Nitrogênio/metabolismo , Rúmen/metabolismo , Rúmen/microbiologia , Amido/administração & dosagemRESUMO
La terapia trombolítica (TT) modifica la historia natural del infarto agudo del miocardio (IAM) al disminuir la morbi-mortalidad. Recientemente, al cambiar la velocidad de infusión, se logró disminuir la mortalidad en 10 puntos porcentuales. Objetivos: Demostrar que la administración de rt-PA en una hora es segura y práctica (administración "rapida"). Material y métodos: Estudio prospectivo cooperativo, llevado a cabo en 3 años, donde se incluyeron a pacientes con el diagnóstico de IAM con menos de 6 hrs de evolución éstos reciberon TT: rt-PA con bolo inicial de 10 mg y los 90 mg en los restantes 60 minutos. Al mismo tiempo del bolo de rt-PA, se administraron 500 UI de heparina y se continuó con infusión de 1000 UI/hr, para mantener TTPa 1.5 a 2 veces el valor basal. Todos los enfermos recibieron ácido acetil salicílico (ASA) y, de acuerdo a la evolución, terapia adyuvante (TA). Se determinó la presencia de sangrado y/o evento cerebral, como puntos finales mayores. Resultados: Se incluyeron en el estudio 225 pacientes, la edad promedio del grupo fue X 57.1 ñ 22.2 años (91 por ciento menores de 75 años): el 78.7 por ciento fueron del sexo masculino y 21.3 por ciento del sexo femenino. El tiempo de retraso en acudir al hospital fue X 2.93 ñ 1.7 hs. El 82.2 por ciento ingresaron en clase funcional I-II de la New York Heart Association (NYHA), el 59.5 por ciento de los infartos fueron de localización anterior y el 32.4 por ciento posteroinferior. El 80 por ciento tuvo criterios de reperfusión clínica. Sólo el 7.1 por ciento requirió de transfusiones y el 0.4 por ciento presentó sangrado a nivel de sistema nervioso central (SNC). La sobrevida fue de 95.2 por ciento a 21 días y la causa de muerte no se relacionó con el sangrado. Conclusiones: El esquema de administración resultó seguro y eficaz, ya que los requerimientos de transfusión no fueron mayores a lo consignado en la literatura y el sangrado del SNC fue del 0.4 por ciento
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Ativadores de Plasminogênio/administração & dosagem , Infarto do Miocárdio/tratamento farmacológico , Estudos Prospectivos , Fatores de TempoRESUMO
UNLABELLED: Thrombolytic therapy (TT) modifies the natural history of acute myocardial infarction (AMI) diminishing morbi-mortality rate. In recent studies, modification of infusion velocity, decreased the mortality 10 percentage points. OBJECTIVE: Test if rt PA administration over an hour is safe and practical. MATERIAL AND METHODS: A prospective, cooperative trial during 3 years, included patients with AMI with less than 6 hours of the onset of symptoms that received rt-PA therapy. Initially 10 mg bolus and then 90 mg over 60 minutes period. Together with the administration of rt-PA, 5000 units of heparin was given, followed by 1000 units per hour adjusted to keep PTT at 1.5 to 2 times normal. All patients received aspirin and according of the evolution adjuvant therapy. We defined bleeding complications and/or cerebrovascular accident related to thrombolytic therapy. RESULTS: We included 225 patients who received rt-PA. Average age was 57.1 +/- 22.2 years, 78.7% males and 21.3% females. Arrival time at hospital was 2.93 +/- 1.7 hours. 82.2% were in class I-II by NYHA. 59.2% had anterior wall location and 32.4% posterior-inferior wall 80% had reperfusion criteria. Only 7.1% required transfusion and 0.4% presented CNS bleeding. The survival rate was 95.2%. The mortality had no relation with bleeding. CONCLUSION: Fast infusion is an effective and safe method. Transfusion requirements are no greater, and CNS bleeding was noted in 0.4% of the cases.
Assuntos
Infarto do Miocárdio/tratamento farmacológico , Ativador de Plasminogênio Tecidual/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de TempoRESUMO
To test the efficacy of intrapleural fibrinolytic therapy in patients with loculated pleural effusions, we conducted an open, prospective, and multicenter trial among five hospitals in Mexico. We enrolled patients with hemothorax or empyema, clotted and/or loculated, that was not resolved through conventional pleural drainage with chest tube and antibiotics in patients with empyema. All patients received repeated doses of 250,000 IU of streptokinase through chest tube. Effectiveness criteria were before and after intrapleural streptokinase (IPSK) drainage, and poststreptokinase radiographic and respiratory function test improvement. Forty-eight patients were studied; there were 30 patients with empyemas, 14 with hemothorax, and 4 patients with malignant pleural effusions without lung trapping. Successful fibrinolysis was obtained in 44 patients, with complete resolution of the pleural collection and adequate radiologic and spirometric improvement. In three of four patients with multiloculated malignant hemothorax with high-yielding pleural drainage, IPSK allowed successful lysis of loci and an adequate pleurodesis was achieved. Only four patients required surgical treatment. The overall success rate in our series was 92%, similar to previous reports. The results in this first prospective and multicentric trial suggest that intrapleural fibrinolysis is an effective and safe adjunctive treatment in patients with heterogeneous pleural coagulated and loculated collections to restore the pulmonary function assessed by respiratory function tests and can obviate surgery in most cases.