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OBJECTIVE: To evaluate the association between different intensive care units and levels of brain monitoring with outcomes in acute brain injury. METHODS: Patients with traumatic brain injury and subarachnoid hemorrhage admitted to intensive care units were included. Neurocritical care unit management was compared to general intensive care unit management. Patients managed with multimodal brain monitoring and optimal cerebral perfusion pressure were compared with general management patients. A good outcome was defined as a Glasgow outcome scale score of 4 or 5. RESULTS: Among 389 patients, 237 were admitted to the neurocritical care unit, and 152 were admitted to the general intensive care unit. Neurocritical care unit management patients had a lower risk of poor outcome (OR = 0.228). A subgroup of 69 patients with multimodal brain monitoring (G1) was compared with the remaining patients (G2). In the G1 and G2 groups, 59% versus 23% of patients, respectively, had a good outcome at intensive care unit discharge; 64% versus 31% had a good outcome at 28 days; 76% versus 50% had a good outcome at 3 months (p < 0.001); and 77% versus 58% had a good outcome at 6 months (p = 0.005). When outcomes were adjusted by SAPS II severity score, using good outcome as the dependent variable, the results were as follows: for G1 compared to G2, the OR was 4.607 at intensive care unit discharge (p < 0.001), 4.22 at 28 days (p = 0.001), 3.250 at 3 months (p = 0.001) and 2.529 at 6 months (p = 0.006). Patients with optimal cerebral perfusion pressure management (n = 127) had a better outcome at all points of evaluation. Mortality for those patients was significantly lower at 28 days (p = 0.001), 3 months (p < 0.001) and 6 months (p = 0.001). CONCLUSION: Multimodal brain monitoring with autoregulation and neurocritical care unit management were associated with better outcomes and should be considered after severe acute brain injury.

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ABSTRACT Objective: To evaluate the association between different intensive care units and levels of brain monitoring with outcomes in acute brain injury. Methods: Patients with traumatic brain injury and subarachnoid hemorrhage admitted to intensive care units were included. Neurocritical care unit management was compared to general intensive care unit management. Patients managed with multimodal brain monitoring and optimal cerebral perfusion pressure were compared with general management patients. A good outcome was defined as a Glasgow outcome scale score of 4 or 5. Results: Among 389 patients, 237 were admitted to the neurocritical care unit, and 152 were admitted to the general intensive care unit. Neurocritical care unit management patients had a lower risk of poor outcome (OR = 0.228). A subgroup of 69 patients with multimodal brain monitoring (G1) was compared with the remaining patients (G2). In the G1 and G2 groups, 59% versus 23% of patients, respectively, had a good outcome at intensive care unit discharge; 64% versus 31% had a good outcome at 28 days; 76% versus 50% had a good outcome at 3 months (p < 0.001); and 77% versus 58% had a good outcome at 6 months (p = 0.005). When outcomes were adjusted by SAPS II severity score, using good outcome as the dependent variable, the results were as follows: for G1 compared to G2, the OR was 4.607 at intensive care unit discharge (p < 0.001), 4.22 at 28 days (p = 0.001), 3.250 at 3 months (p = 0.001) and 2.529 at 6 months (p = 0.006). Patients with optimal cerebral perfusion pressure management (n = 127) had a better outcome at all points of evaluation. Mortality for those patients was significantly lower at 28 days (p = 0.001), 3 months (p < 0.001) and 6 months (p = 0.001). Conclusion: Multimodal brain monitoring with autoregulation and neurocritical care unit management were associated with better outcomes and should be considered after severe acute brain injury.

RESUMO Objetivo: Avaliar a associação entre diferentes tipos de unidades de cuidados intensivos e os níveis de monitorização cerebral com desfechos na lesão cerebral aguda. Métodos: Foram incluídos doentes com traumatismo craniencefálico e hemorragia subaracnoide internados em unidades de cuidados intensivos. A abordagem na unidade de cuidados neurocríticos foi comparada à abordagem na unidade de cuidados intensivos polivalente geral. Os doentes com monitorização cerebral multimodal e pressão de perfusão cerebral ótima foram comparados aos que passaram por tratamento geral. Um bom desfecho foi definido como pontuação de 4 ou 5 na Glasgow outcome scale. Resultados: Dos 389 doentes, 237 foram admitidos na unidade de cuidados neurocríticos e 152 na unidade de cuidados intensivos geral. Doentes com abordagem em unidades de cuidados neurocríticos apresentaram menor risco de um mau desfecho (Odds ratio = 0,228). Um subgrupo de 69 doentes com monitorização cerebral multimodal (G1) foi comparado aos demais doentes (G2). Em G1 e G2, respectivamente, 59% e 23% dos doentes apresentaram bom desfecho na alta da unidade de cuidados intensivos; 64% e 31% apresentaram bom desfecho aos 28 dias; 76% e 50% apresentaram bom desfecho aos 3 meses (p < 0,001); e 77% e 58% apresentaram bom desfecho aos 6 meses (p = 0,005). Quando os desfechos foram ajustados para o escore de gravidade do SAPS II, usando o bom desfecho como variável dependente, os resultados foram os seguintes: para o G1, em comparação ao G2, a odds ratio foi de 4,607 na alta da unidade de cuidados intensivos (p < 0,001), 4,22 aos 28 dias (p = 0,001), 3,250 aos 3 meses (p = 0,001) e 2,529 aos 6 meses (p = 0,006). Os doentes com abordagem da pressão de perfusão cerebral ótima (n = 127) apresentaram melhor desfecho em todos os momentos de avaliação. A mortalidade desses doentes foi significativamente menor aos 28 dias (p = 0,001), aos 3 meses (p < 0,001) e aos 6 meses (p = 0,001). Conclusão: A monitorização cerebral multimodal com autorregulação e abordagem na unidade de cuidados neurocríticos foi associado a melhores desfechos e deve ser levado em consideração após lesão cerebral aguda grave.

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Background: The coronavirus disease-2019 (COVID-19) pandemic has predominantly affected the adult population, but with a significantly lower prevalence in children. Most pediatric patients with COVID-19 have mild course; however, a small number progressed to acute respiratory distress syndrome, hypoxemia, despite optimized conventional therapies. Thus, this study aimed to report a series of six cases of children with severe acute respiratory syndrome coronavirus 2 infection who were supported by extracorporeal membrane oxygenation (ECMO) due to refractory hypoxemic respiratory failure. Methods: This observational, retrospective, and descriptive study reported a series of cases. Data were retrospectively collected from the medical records of patients who were admitted to the Pediatric Cardiologic Intensive Care of Hospital Dr. Carlos Alberto Studart Gomes and Hospital Regional da Unimed, between March 1, 2020, and June 30, 2021. Sociodemographic, clinical, and laboratory data were analyzed. Findings: The median age was 1.8 years (range: 0.4-14.5 years), 66.7% were males, and weight varied from 13 to 110 kg. The mean time between the onset of symptoms and cannulation, ECMO duration, and ventilation time were 15 days (range: 6-24 days)], 11 days (range: 6-19 days), and 20.5 days (range: 14-33 days), respectively. Five (83.3%) children were successfully decannulated and four survived with hospital discharge. One child died on ECMO support due to multiple organ dysfunction syndromes after 13 days and another one died 3 days after decannulation due to extensive hemorrhagic stroke. Our case series revealed a 33.3% in-hospital mortality rate. ECMO appears as a viable intervention in selected patients who failed conventional therapies in the pediatric population. Funding: This observational study received no funding.

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Acute kidney injury (AKI) is characterized by a sudden decrease in kidney function. Children with congenital heart disease are a special group at risk of developing AKI. We performed a systematic review of the literature to search for studies reporting the usefulness of novel urine, serum, and plasma biomarkers in the diagnosis and progression of AKI and their association with clinical outcomes in children undergoing pediatric cardiac surgery. In thirty studies, we analyzed the capacity to predict AKI and poor outcomes of five biomarkers: Cystatin C, Neutrophil gelatinase-associated lipocalin, Interleukin-18, Kidney injury molecule-1, and Liver fatty acid-binding protein. In conclusion, we suggest the need for further meta-analyses with the availability of additional studies.

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Objective: To report a case of prenatal diagnosis of cardiac rhabdomyoma (CR) and neonatal surgical treatment as well as undertaking a systematic review of the literature to determine most frequent localization of CR, common signs and symptoms, associated pathologies, incidence of surgery, and prognoses for CR.Methods: We conducted systematic review of the literature on CR that were diagnosed and treated in the perinatal period, searching for English language articles in the PubMed/Medline database that were published within the past 20 years, using the following search terms: "cardiac rhabdomyoma"; "neonates"; "newborn"; "surgery".Results: Eighty-two studies were selected, but only 46 studies met the inclusion criteria. After birth, the majority of newborns were asymptomatic; however, murmurs and arrhythmia were also the two most prevalent signs of CR. The most prevalent location was the ventricles, corresponding to 40.3% of all cases, with 53% of these having a rhabdomyoma in the left ventricle. The incidence of multiple tumors was 56%, and in those cases the location of tumors was also most common in the ventricles. Tuberous sclerosis was the most commonly associated pathology, being present in 72% of cases of CR. Surgical treatment occurred in 27% of cases, and 3% of cases required surgery and prostaglandin. Regarding the perinatal outcome, 6% of cases resulted in fetal or neonatal death.Conclusion: CR are benign tumors which tend to spontaneously regress during early childhood but may have unfavorable outcomes in the presence of obstructive lesions and arrhythmias. Surgery is generally necessary in symptomatic patients.

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Visceral leishmaniasis (VL) is associated with interstitial pneumonitis according to histology and radiology reports. However, studies to address the functional impact on respiratory function in patients are lacking. We assessed pulmonary function using noninvasive spirometry in a cross-sectional study of hospitalized adult VL patients from Minas Gerais, Brazil, without unrelated lung conditions or acute infections. Lung conditions were graded as normal, restrictive, obstructive, or mixed patterns, according to Brazilian consensus standards for spirometry. To control for regional patterns of lung function, we compared spirometry of patients with regional paired controls. Spirometry detected abnormal lung function in most VL patients (70%, 14/20), usually showing a restrictive pattern, in contrast to regional controls and the standards for normal tests. Alterations in spirometry measurements correlated with hypoalbuminemia, the only laboratory value indicative of severity of parasitic disease. Abnormalities did not correlate with unrelated factors such as smoking or occupation. Clinical data including pulmonary symptoms and duration of therapy were also unrelated to abnormal spirometry findings. We conclude that the severity of VL is correlated with a restrictive pattern of lung function according to spirometry, suggesting that there may be interstitial lung involvement in VL. Further studies should address whether spirometry could serve as an index of disease severity in the management of VL.

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The perspective of the integrated health system has a network of care with multiple integration dimensions among subsystems as nuclear representation, relating the clinical aspects and governance to the representations and collective values. The normative integration aims to ensure coherence between the system of representations and values of society simultaneously with the interfaces of clinical and functional integration. It builds a bridge with governance, which allows, through their skills, management of all system components, encouraging cooperation, communication and information, in order to ensure the population under their responsibility to access excellence services, exceeding their expectations. The integration of care consists of a durable coordination of clinical practices for those who suffer from health problems in order to ensure continuity and full range of the required professional services and organizations, coordinated in time and space, in accordance with the available knowledge. It is possible to establish the type of health equipment for each level of care for patients with congenital heart diseases. This strategy intends to offer timely care in appropriate moments and places, efficiently, operating cooperatively an interdependently, with ongoing exchange of its resources. Thus, situational integration establishes the system connection with the assessment environment that proposes to carry out value judgment, guided by an objective worldview, about an intervention or any of its components, in order to objectify the decision making.

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ABSTRACT The perspective of the integrated health system has a network of care with multiple integration dimensions among subsystems as nuclear representation, relating the clinical aspects and governance to the representations and collective values. The normative integration aims to ensure coherence between the system of representations and values of society simultaneously with the interfaces of clinical and functional integration. It builds a bridge with governance, which allows, through their skills, management of all system components, encouraging cooperation, communication and information, in order to ensure the population under their responsibility to access excellence services, exceeding their expectations. The integration of care consists of a durable coordination of clinical practices for those who suffer from health problems in order to ensure continuity and full range of the required professional services and organizations, coordinated in time and space, in accordance with the available knowledge. It is possible to establish the type of health equipment for each level of care for patients with congenital heart diseases. This strategy intends to offer timely care in appropriate moments and places, efficiently, operating cooperatively an interdependently, with ongoing exchange of its resources. Thus, situational integration establishes the system connection with the assessment environment that proposes to carry out value judgment, guided by an objective worldview, about an intervention or any of its components, in order to objectify the decision making.

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Introdução: no Brasil, o processo de envelhecimento dapopulação deve-se ao rápido declínio das taxas de mortalidadee de fecundidade. Em 2050, os idosos corresponderãoa 14,2% da população brasileira. Um dos fatoresrelacionados ao envelhecimento sadio é a boa nutriçãodurante toda a vida Objetivo: avaliar o consumo alimentarde idosos de uma instituição de longa permanência domunicípio de Belo Horizonte, Minas Gerais. Materiais eMétodos: foi realizado um estudo transversal desenvolvidoem uma instituição geriátrica localizada no municípiode Belo Horizonte - MG, com 30 idosos, na faixa etáriade 70 a 79 anos. O consumo alimentar foi caracterizadomediante inquérito alimentar 24 horas, aplicado em triplicata.Os dados foram avaliados de acordo com as recomendaçõespropostas pela Pirâmide Alimentar adaptada.Resultados e Discussão: 77% (n=23) eram mulheres,e 23% (n=07) homens. O grupo de alimento com maiorinadequação no consumo em comparação com as recomendaçõesfoi o das Hortaliças (22,5% de adequação). Osgrupos dos Óleos e Gorduras, e Açúcares e Doces atingiram100% do recomendado. Conclusão: existe um desequilí-brio no consumo alimentar dos idosos institucionalizados.É necessária a implementação de medidas como modificaçõesdietéticas e programas de educação alimentar.

Introduction: In Brazil, the population aging process isdue to the rapid decline in mortality and fecundity rates. In2050, the elderly will correspond to 14.2% of the Brazilianpopulation. One of the factors related to healthy aging isgood nutrition across one's lifetime. Aim: To assess foodintake among the elderly at a long-term institution in BeloHorizonte, Minas Gerais, Brazil. Material and Methods:A cross-sectional study developed at a geriatric institutionlocated in Belo Horizonte, MG, was conducted involving30 elderly persons between 70 and 79 years of age. Foodintake was characterized through a 24-hour food recall,applied threefold. Data were assessed according to therecommendations proposed in the adapted Food Pyramid.Results and Discussion: 77% (n=23) were womenand 23% (n=7) men. The food group with the highestpercentage of inadequate consumption when comparedwith recommendations was Greenery (22.5% of adequacy).The group Oils and Fats, and Sugars and Sweets reached 100%of recommendations. Conclusion: Disequilibrium existsin institutionalized elderly people?s food intake. Measureslike diet modification and food education programs areneeded.

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Introdução: a principal causa de morte em todo o mundo é a doença cardiovascular. Objetivo: demonstrar a importância do aconselhamento nutricional para tratamento de dislipidemias em idosos, ressaltando-se os benefícios das intervenções dietéticas sobre a saúde cardiovascular, de forma a estimular estratégias e difundir esse importante recurso terapêutico. Método: pesquisa realizada a partir de bancos de dados, biblioteca virtual, livros técnicos e publicações de órgãos nacionais e internacionais, Organização Mundial de Saúde, Sociedade Brasileira de Cardiologia e Ministério da Saúde, de 2000 a 2007, limite de idade 60 anos ou mais. Foram usados os descritores dislipidemia ou dislypidemia, aconselhamento nutricional ou nutrional counseling e idoso ou elderly, totalizando 18 artigos, com inclusão de uma metanálise, sendo nove artigos de revisão bibliográfica e nove de resultados. Resultado: a recomendação para se manter saudável é o equilíbrio entre o consumo de calorias ingeridas e o gasto energético. Recomendações específicas são: consumir alimentação com baixo teor de açúcar e sal; aumentar o consumo de fibras e soja; manter peso corporal ideal; praticar atividade física regularmente; não usar cigarro; controlar estresse e consumo de álcool; e manter na normalidade o perfil lipídico, pressão arterial e glicemia. Duas diretrizes americanas e brasileiras são as proposições mais amplas de aconselhamento nutricional para dislipidêmicos. Conclusão: a adoção de alimentação e de estilo de vida saudáveis é medida essencial para reduzir a incidência de doenças cardiovasculares. Essas recomendações, quando adotadas, reduzem substancialmente o risco do desenvolvimento de doenças cardiovasculares.

Introduction: Cardiovascular disease is the main cause of death in the world. Objective: To show the importance of nutritional counseling in the treatment of elderly patients with dyslipidemia, to show the benefits of dietary interventions on patients? cardiovascular health, and to encourage the development of strategies to spread this important treatment resource. Method: The research focuses on data of patients of 60 years or older found on databanks, virtual libraries, technical manuals, and publications of national and international bodies, such as the World Health Organization, the Brazilian Society of Cardiology, and the Brazilian Ministry of Health, from 2000 through 2007. The data search for Portuguese and English-language descriptors for dyslipidemia, nutritional counseling, and distrielderly resulted in 18 papers (9 focusing on review of the literature, and 9 focusing on reporting results) and one meta-analysis article. Results: The major health advice is balancing calorie consumption and energy expenditure. Major recommendations are: To opt for low-sugar and low-salt food; to eat more fibers and soy; to maintain ideal body weight; to practice physical activities regularly; to avoid smoking; to control stress and alcohol abuse; and to keep normal levels of lipids, arterial pressure, and glycaemia. Two North-American and Brazilian guidelines put forward broader proposals of including nutritional counseling for patients with dyslipidemia. Conclusion: Healthy food and life styles are crucial measures to reduce the incidence of cardiovascular diseases. The adoption of recommendations significantly reduce the risk of developing such disease.