RESUMO
OBJECTIVES: Positive fluid balance is frequent in critically ill patients and has been considered a potential biomarker for acute kidney injury (AKI). This study aimed to evaluate positive fluid balance as a biomarker for the early detection of AKI in critically ill patients. METHODS: This was a prospective cohort study. The sample was composed of patients ≥18 years old who stayed ≥3 days in an intensive care unit. Fluid balance, urinary output and serum creatinine were assessed daily. AKI was diagnosed by the Kidney Disease Improving Global Outcome criteria. RESULTS: The final cohort was composed of 233 patients. AKI occurred in 92 patients (40%) after a median of 3 (2-6) days following ICU admission. When fluid balance was assessed as a continuous variable, a 100-ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI (OR 1.04; 95% CI 1.01-1.08). Positive fluid balance categorized using different thresholds was always significantly associated with subsequent detection of AKI. The mixed effects model showed that increased fluid balance preceded AKI by 4 to 6 days. CONCLUSION: These results suggest that a positive fluid balance might be an early biomarker for AKI development in critically ill patients.
Assuntos
Injúria Renal Aguda , Estado Terminal , Injúria Renal Aguda/diagnóstico , Adulto , Biomarcadores , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos , Equilíbrio HidroeletrolíticoRESUMO
OBJECTIVES: Positive fluid balance is frequent in critically ill patients and has been considered a potential biomarker for acute kidney injury (AKI). This study aimed to evaluate positive fluid balance as a biomarker for the early detection of AKI in critically ill patients. METHODS: This was a prospective cohort study. The sample was composed of patients ≥18 years old who stayed ≥3 days in an intensive care unit. Fluid balance, urinary output and serum creatinine were assessed daily. AKI was diagnosed by the Kidney Disease Improving Global Outcome criteria. RESULTS: The final cohort was composed of 233 patients. AKI occurred in 92 patients (40%) after a median of 3 (2-6) days following ICU admission. When fluid balance was assessed as a continuous variable, a 100-ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI (OR 1.04; 95% CI 1.01-1.08). Positive fluid balance categorized using different thresholds was always significantly associated with subsequent detection of AKI. The mixed effects model showed that increased fluid balance preceded AKI by 4 to 6 days. CONCLUSION: These results suggest that a positive fluid balance might be an early biomarker for AKI development in critically ill patients.
Assuntos
Humanos , Adulto , Estado Terminal , Injúria Renal Aguda/diagnóstico , Equilíbrio Hidroeletrolítico , Biomarcadores , Estudos Prospectivos , Unidades de Terapia IntensivaRESUMO
Sugarcane harvesting has been associated with an epidemic of chronic kidney disease in Central America mainly affecting previously healthy young workers. Repeated episodes of acute kidney dysfunction are hypothesized to be one of the possible mechanisms for this phenomenon. Therefore, this exploratory study aimed to assess the acute effects of burnt sugarcane harvesting on renal function among 28 healthy non-African Brazilian workers. Urine and blood samples were collected at the beginning and at the end of the harvesting season and before and at the end of a harvesting workday. All individuals decreased their estimated glomerular filtration rate by â¼20% at the end of the daily shift, and 18.5% presented with serum creatinine increases consistent with acute kidney injury. Those changes were associated with increased serum creatine phosphokinase (a known marker for exertional rhabdomyolysis) and oxidative stress-associated malondialdehyde levels, increased peripheral blood white cell counts, decreased urinary and serum sodium, decreased calculated fractional sodium excretion, and increased urine density. Thus, burnt sugarcane harvesting caused acute renal dysfunction in previously healthy workers. This was associated with a combination of dehydration, systemic inflammation, oxidative stress, and rhabdomyolysis.
Assuntos
Injúria Renal Aguda/fisiopatologia , Agricultura , Doenças Profissionais/fisiopatologia , Exposição Ocupacional/efeitos adversos , Saccharum , Injúria Renal Aguda/etiologia , Adulto , Brasil , Creatina Quinase/sangue , Creatinina/sangue , Taxa de Filtração Glomerular , Humanos , Contagem de Leucócitos , Masculino , Malondialdeído/sangue , Cãibra Muscular/sangue , Doenças Profissionais/etiologia , Estudos Prospectivos , Sódio/sangue , Sódio/urina , Gravidade Específica , Urinálise , Adulto JovemRESUMO
Este estudo apresenta características gerais de famílias nas quais houve a ocorrência de violência doméstica contra crianças, e avalia os resultados de seu acompanhamento pelo Centro Regional de Atenção aos Maus-Tratos na Infância (CRAMI-Rio Preto). Foram entrevistadas cinqüenta e cinco famílias, que responderam um questionário estruturado. A forma de violência mais prevalente foi a física, presente em 58 por cento dos casos. Sessenta por cento das vítimas são do sexo feminino, e a mãe é agressora em 49 por cento das situações analisadas. Os principais fatores desencadeantes da violência, identificados pelas famílias, são conflitos do casal (58 por cento), características próprias da criança (51 por cento) e histórico de vida dos pais (49 por cento). A maioria das famílias (80 por cento) acredita que a intervenção proporcionou interrupção ou diminuição na intensidade da violência e a forma de acompanhamento que mais houve adesão dos pais foi por meio das visitas domiciliares. Observa-se que a intervenção junto dessas famílias pode ter resultados satisfatórios, desde que a violência possa ser compreendida em seus vários aspectos, ou seja, um sintoma presente no grupo familiar modelado por dificuldades de diferentes naturezas: cultural, social, econômica e das relações interpessoais.
Assuntos
Maus-Tratos Infantis , Adolescente , Criança , Violência DomésticaRESUMO
BACKGROUND: Although acute renal failure (ARF) is a frequent complication of severe leptospirosis, there are few studies on renal function recovery in the literature. The objective of the present study was to verify how and when renal function recovery occurs after leptospirosis ARF. PATIENTS AND METHODS: 35 patients with leptospirosis ARF (plasma creatinine [P(creat)] > or =133 micromol/l at hospital admission) were prospectively studied during hospitalization, at discharge and 3 and 6 months after discharge. Creatinine clearance, fractional excretion of sodium and potassium, proteinuria and sodium proximal reabsorption were measured under normal sodium diet. Urinary pH and the ratio urinary to plasma osmolality (U/P(osm)) were measured 18 h after food and water withdrawal. All parameters were also measured in 18 healthy volunteers. Presence of laboratorial alterations usually found in leptospirosis were evaluated in the patients. Patients were divided in 2 groups according to their maximum P(creat) value during hospitalization: group 1 ( P(creat) >442 micromol/l, n = 21), and group 2 (P(creat) < or =442 micromol/l, n = 14). RESULTS: All patients presented with jaundice, fever and myalgia. Bilirubin and creatine kinase were higher in group 1. Oliguria was observed in 11% of all patients and 49% required dialysis; all these patients were from group 1. All renal parameters were normal at the 6th month except U/P(osm) that remained lower than normal. The pattern of renal function recovery was similar in both groups except for urinary volume. CONCLUSION: After leptospirosis ARF, renal function recovery is fast and complete after 6 months, except for urinary concentration capacity.
Assuntos
Injúria Renal Aguda/fisiopatologia , Testes de Função Renal , Leptospirose/complicações , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Adulto , Feminino , Humanos , Tempo de Internação , Leptospirose/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Estudos Prospectivos , Recuperação de Função Fisiológica , Diálise Renal , Resultado do TratamentoRESUMO
UNLABELLED: The aim of this study was to determine the prevalence of epilepsy in the urban population of São José do Rio Preto. This is a medium-sized city of 336000 inhabitants, located in the northwest of the state of São Paulo, Brazil. METHOD: A cross-sectional epidemiological investigation with a randomized sample was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The chi-square test was used in analysis of the results and p-value value < 0.05 was considered significant. Prevalence was calculated with 95% confidence interval. RESULTS: The study sample size was 17293 individuals, with distributions of gender, age, and race similar to the general population. The prevalence per 1000 inhabitants of epilepsy was 18.6, of these 8.2 were active, defined as at least one seizure within the last two years. The prevalence per 1000 inhabitants for the age groups (years) was 4.9 (04), 11.7 (514), 20.3 (1564) and 32.8 (65 or over). CONCLUSION: Prevalence of both accumulated and active epilepsy was elevated, comparable to other developing nations, in particular those of Latin America. However, the prevalence of epilepsy in childhood was low, whilst in aged individuals it was high similar to industrialized nations.
Assuntos
Epilepsia/epidemiologia , População Urbana , Adolescente , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Vigilância da População , Inquéritos e QuestionáriosRESUMO
ANTECEDENTES: O objetivo deste estudo foi determinar a prevalência da epilepsia na população urbana de São José do Rio Preto, com 336000 habitantes, localizada no noroeste do Estado de São Paulo/ Brasil. MÉTODO: O estudo populacional, tipo corte transversal, em amostra aleatória, constituiuse de uma fase de rastreamento, mediante um questionário. O padrão ouro para confirmação diagnóstica foi a história clínica e o exame neurológico. Os testes do c2 e intervalo de confiança de 95% (IC95%) foram usados para análise dos resultados, tendo sido considerados significantes os de valor p< 0,05. RESULTADOS: A amostra estudada foi de 17293 pessoas, cuja distribuição quanto ao sexo, à faixa etária e à raça foram semelhantes à da população em geral. A prevalência de epilepsia por 1000 hab. foi 18,6, sendo 8,2 para ativa considerandose, pelo menos, uma crise no período dos últimos 2 anos. A prevalência na faixa etária de 0 a 4 anos foi 4,9, de 5 a 14, 11,7; de 15 a 64, 20,3; e acima dos 65 anos foi 32,8. CONCLUSÃO: As prevalências de epilepsia acumulada e ativa foram elevadas, semelhantes às dos países em desenvolvimento, em particular, aos da América Latina. A prevalência de epilepsia na infância foi baixa, enquanto que nos idosos foi elevada, semelhantes às observadas em países desenvolvidos. Estes resultados são relevantes no planejamento de medidas sanitárias, adequação ao tratamento da população, considerando a alta prevalência encontrada, para minimizar o impacto da epilepsia na população.
Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Epilepsia/epidemiologia , População Urbana , Distribuição por Idade , Brasil/epidemiologia , Métodos Epidemiológicos , Vigilância da População , Inquéritos e QuestionáriosRESUMO
O risco de infecção tuberculosa e doença pelo Mycobacterium tuberculosis em profissionais de saúde temrecebido atenção desde a década de 1990, quando a morbidade e mortalidade associadas à doença aumentaramna comunidade em geral. A importância da exposição ocupacional no comprometimento desses indivíduos é variável nas diversas instituições e localidades. Manuais orientando práticas de trabalho e medidas de controle ambiental com objetivo de também diminuir essa exposição têm sido elaborados por comitês em vários países. Este texto apresenta revisão das evidências do risco ocupacional da tuberculose, dos fatores envolvidos, das medidas apresentadas por vários manuais e os aspectos valorizados em cada um, de acordo com as diferentes características das instituições.