Metastatic clear-cell renal carcinoma: an exceptional cause of ileocolonic intussusception in adults

Introduction: Intussusceptions in adults are rare, representing 1% to 5% of intestinal obstructions in this age group. This condition can be caused by benign and malignant lesions acting as lead points, the latter being the most frequent. Furthermore, the diagnosis is challenging due to the non-specific symptoms with variable duration. Case Presentation: A 43-year-old man, with a history of localized clear-cell renal carcinoma (ccRCC) treated 9 years earlier with a right radical nephrectomy, presented with bowel obstruction symptoms. An abdominal computed tomography scan showed an ileocolonic intussusception. Hence, the patient required a right hemicolectomy with ileotransverse anastomosis. The histopathological analysis showed a metastatic ccRC to the terminal ileum causing the intussusception. Discussion: Adult intussusceptions are rare. However, they should be considered in the differential diagnosis of patients with abdominal pain and symptoms of bowel obstruction. Metastases of renal cancer to the small bowel are uncommon and even more so in the form of intussusception. Definitive treatment must be tailored to the patient's condition and underlying cause. (AU)

Evaluación del Orbit Bleeding Risk Score como predictor de sangrado mayor en pacientes con síndrome coronario agudo / Evaluation of the Orbit Bleeding Risk Score as Predictor of Major Bleeding in Patients with Acute Coronary Syndrome

RESUMEN Introducción: El sangrado mayor es la complicación más importante del tratamiento antitrombótico en el síndrome coronario agudo (SCA), y se asocia a mayor mortalidad. Evaluar el riesgo de sangrado es un desafío. La utilidad del Orbit Bleeding score (ORBIT) para evaluar el riesgo de sangrado en SCA ha sido poco estudiada. Objetivo: Evaluar al ORBIT como predictor de sangrado mayor en pacientes internados por SCA en los que se decide la anticoagulación como parte de la estrategia antitrombótica. Materiales y métodos: Se incluyeron en forma retrospectiva pacientes internados en dos unidades coronarias con diagnóstico de SCA que recibieron anticoagulación como parte de la terapia antitrombótica. A todos se les calcularon los scores CRUSADE, ACTION-GWTG y ORBIT con los datos clínicos del ingreso. Se analizo el punto primario de sangrado mayor, definido como una clasificación de BARC 3 o 5. Resultados: Se incluyeron 762 pacientes. El sangrado mayor se presentó en el 3.4%. En el análisis univariado los tres scores fueron predictores de sangrado mayor, mientras que en el multivariado sólo el ORBIT fue predictor independiente de sangrado mayor, con OR 2,46, IC95% 1,61-3,97, p <0,001. El área bajo la curva ROC fue de 0,70, 0,68 y 0,80 para los scores ACTIONGWTG, CRUSADE y ORBIT, respectivamente. El ORBIT presento una mayor área bajo la curva que el CRUSADE (p = 0,03) sin diferencias significativas con el ACTION-GWTG (p = 0,06) Conclusiones: El ORBIT fue el único predictor independiente de sangrado mayor, con una mejor capacidad de discriminación que el CRUSADE, y tendencia a mejor capacidad que el ACTION-GWTG.

ABSTRACT Background: Major bleeding is the most important complication of antithrombotic treatment in acute coronary syndrome (ACS) and is associated with higher mortality. Assessing the risk of bleeding is a challenge. The usefulness of the Orbit Bleeding Score (ORBIT) to assess the risk of bleeding in ACS has been scarcely studied. Objective: The aim of this study was to evaluate the ORBIT score as a predictor of major bleeding in patients hospitalized for ACS in whom anticoagulation is decided as part of the antithrombotic strategy. Methods: Patients admitted to two coronary care units with diagnosis of ACS who received anticoagulation as part of the antithrombotic therapy were retrospectively included in the study. The CRUSADE, ACTION-GWTG and ORBIT scores were calculated using the admission clinical data. The primary endpoint was major bleeding, defined as BARC 3 or 5 classification. Results: The study included 762 patients. Major bleeding occurred in 3.4% of cases. In the univariate analysis, the three scores were predictors of major bleeding, while in the multivariate analysis only the ORBIT score was an independent predictor of major bleeding (OR: 2.46, 95% CI 1.61-3.97, p <0.001). The area under the ROC curve was 0.70, 0.68 and 0.80 for the ACTION-GWTG, CRUSADE and ORBIT scores, respectively. The ORBIT score presented a higher area under the curve than the CRUSADE score (p=0.03) but without significant difference with the ACTION-GWTG score (p=0.06) Conclusions: The ORBIT score was the only independent predictor of major bleeding, presenting a better discrimination capacity than the CRUSADE score and a tendency to better capacity than the ACTION-GWTG score.

Medición de la mortalidad de pacientes internados por enfermedad cardiovascular mediante el desarrollo de un algoritmo de inteligencia artificial / Measurement of mortality during hospitalization due cardiovascular disease through the development of an artificial intelligence algorithm

Introducción: determinar la causa de muerte de los pacientes internados con enfermedad cardiovascular es de suma importancia para poder tomar medidas y así mejorar la calidad su atención y prevenir muertes evitables. Objetivos: determinar las principales causas de muerte durante la internación por enfermedades cardiovasculares. Desarrollar y validar un algoritmo para clasificar automáticamente a los pacientes fallecidos durante la internación con enfermedades cardiovasculares Diseño del estudio: estudio exploratorio retrospectivo. Desarrollo de un algoritmo de clasificación. Resultados: del total de 6161 pacientes, el 21,3% (1316) se internaron por causas cardiovasculares; las enfermedades cerebrovasculares representan el 30,7%, la insuficiencia cardíaca el 24,9% y las enfermedades cardíacas isquémicas el 14%. El algoritmo de clasificación según motivo de internación cardiovascular vs. no cardiovascular alcanzó una precisión de 0,9546 (IC 95%: 0,9351-0,9696). El algoritmo de clasificación de causa específica de internación cardiovascular alcanzó una precisión global de 0,9407 (IC 95%: 0,8866-0,9741). Conclusiones: la enfermedad cardiovascular representa el 21,3% de los motivos de internación de pacientes que fallecen durante su desarrollo. Los algoritmos presentaron en general buena performance, particularmente el de clasificación del motivo de internación cardiovascular y no cardiovascular y el clasificador según causa específica de internación cardiovascular. (AU)

Introduction: determining the cause of death of hospitalized patients with cardiovascular disease is of the utmost importance in order to take measures and thus improve the quality of care of these patients and prevent preventable deaths. Objectives: to determine the main causes of death during hospitalization due to cardiovascular diseases.To development and validate a natural language processing algorithm to automatically classify deceased patients according to their cause for hospitalization. Design: retrospective exploratory study. Development of a natural language processing classification algorithm. Results: of the total 6161 patients in our sample who died during hospitalization, 21.3% (1316) were hospitalized due to cardiovascular causes. The stroke represent 30.7%, heart failure 24.9%, and ischemic cardiac disease 14%. The classification algorithm for detecting cardiovascular vs. Non-cardiovascular admission diagnoses yielded an accuracy of 0.9546 (95% CI 0.9351, 0.9696), the algorithm for detecting specific cardiovascular cause of admission resulted in an overall accuracy of 0.9407 (95% CI 0.8866, 0.9741). Conclusions: cardiovascular disease represents 21.3% of the reasons for hospitalization of patients who die during hospital stays. The classification algorithms generally showed good performance, particularly the classification of cardiovascular vs non-cardiovascular cause for admission and the specific cardiovascular admission cause classifier. (AU)

Índice PROFUND y mortalidad intrahospitalaria en pacientes pluripatológicos. Análisis post-hoc / PROFUND index and intrahospital mortality in plurypathological patients. A post-hoc analysis

Resumen El índice PROFUND se desarrolló y validó para predecir mortalidad a 12 meses en pacientes pluripatológicos. Sin embargo, su valor potencial para predecir mortalidad intrahospitalaria no ha sido suficientemente estudiado. Se evaluó la capacidad del índice PROFUND en comparación con la proteína C re activa (PCR), la albúmina, y el ancho de distribución eritrocitaria (ADE) para predecir mortalidad intrahospitalaria, mediante el análisis posterior de una cohorte prospectiva de 111 pacientes pluripatológicos internados en clínica médica. La edad promedio fue 75.8 ± 9.3 años. La mortalidad intrahospitalaria fue de 17% (19 pacientes). La mediana (RIQ) del índice PROFUND, albúmina, PCR y ADE en los fallecidos y sobrevivientes fue 12 (4) y 6 (7) p< 0.0001, 2.5 (0.4) y 2.6 (0.8) p 0.295, 58 (64) y 40 (60) p 0.176, 14.5 (2) y 14.6 (3) p 0.523, respectivamente. El análisis logístico multivariado mostró que el índice PROFUND se asocia con mortalidad intrahospitalaria (p 0.0003). El riesgo de fallecer durante la internación es 20% mayor por cada punto que se incrementa el índice PROFUND (OR 1.2, IC95% 1.1-1.4). El área bajo la curva de las características operativas del receptor (AUC-ROC) del índice PROFUND para predecir mortalidad durante la internación (0.760, IC95% 0.628-0.891) fue mayor a la del ADE, PCR y albúmina (0.494 IC95% 0.364-0.624 p 0.012; 0.583 IC95% 0.437-0.728 p 0.028; 0.621 0.494-0.748 p 0.109, respectivamente). El índice PROFUND se asocia a mortalidad intrahospitalaria, con una mayor capacidad predictiva que los biomarcadores estudiados, lo cual se sumaría a su valor pronóstico a largo plazo en pacientes pluripatológicos.

Abstract The PROFUND index was developed and valid to predict mortality at 12 months in polypathological patients (PP). However, its potential value for predicting in-hospital mortality has not been sufficiently studied. The ability of the PROFUND index in comparison with C-reactive protein (CRP), albumin, and red blood cell distribu tion width (RDW) to predict in-hospital mortality was evaluated through the subsequent analysis of a prospective cohort of 111 multiple pathological patients admitted to the clinic medical. The mean age was 75.8 ± 9.3 years. In-hospital mortality was 17% (19 patients). The median (IQR) of the PROFUND index, albumin, CRP and ADE in the deceased and survivors was 12 (4) and 6 (7) p < 0.0001, 2.5 (0.4) and 2.6 (0.8) p 0.295, 58 (64) and 40 (60) p 0.176, 14.5 (2) and 14.6 (3) p 0.523, respectively. The multivariate logistic analysis showed that the PROFUND index is associated with in-hospital mortality (p 0.0003). The risk of dying during hospitalization is 20% higher for each point that the PROFUND index increases (OR 1.2, 95% CI 1.1-1.4). The area under the curve the receiver operating characteristic (AUC-ROC) of the PROFUND index to predict mortality during hospitalization (0.760, 95% CI 0.628-0.891) was higher than that of the RDW, CRP and albumin (0.494 95% CI 0.364-0.624 p 0.012; 0.583 95% CI 0.437-0.728 p 0.028; 0.621 0.494-0.748 p 0.109, respectively). The PROFUND index is associated with in-hospital mortality, with a greater predictive capacity than the biomarkers studied, which would add to its long-term prognostic value in multiple pathological patients.

Urorectal fistula repair using different approaches: operative results and quality of life issues

ABSTRACT Purpose: To evaluate efficacy of urorectal fistula (URF) repair using different approaches and the clinical factor determinant of success, and also the morbidity associated to the procedure and health-related quality of life (HRQoL) in male survivors of pelvic malignancies. Material and Methods: Retrospective evaluation of 39 patients with URF primarily intervened in three institutions using different surgical approaches. Success was defined as effective fistula closure. Variables evaluated included demographics, previous treatments, surgical approach, ancillary surgeries, complications and HRQoL by using a standardized non-validated specific questionnaire. Median follow-up from surgery to interview was 55 months (interquartile range 49, range 4-112). Factors determinant of success were investigated using logistic regression. Safety of the procedure was evaluated by Clavien-Dindo scale. Deterioration of continence and erectile function and other HRQoL issues were evaluated. Results: Prostate cancer treatment was the predominant etiology. The success rate for fistula repair was 89.5%. The surgical approach was not related to failed repair (p=0.35) or complications (p=0.29). Factors associated with failure were complications (p=0.025), radiotherapy (p=0.03), fistula location (p=0.04) and fistula size (p=0.007). Multivariate analysis revealed fistula size was the only independent determinant of failure (OR 6.904, 1.01-47.75). Complications occurred in 46.2% and severe complications in 12.8%. The mortality related to the procedure was 2.6%. Urinary incontinence was present before repair in 26.3% and erectile dysfunction in 89.5%. Fistula repair caused de novo urinary incontinence in 7.9% and deterioration of erectile status in 44.7%. Globally 79% were satisfied after repair and only 7.9% rated HRQoL as unhappy. Trans-sphincteric approach was related to less deterioration of erectile function (p=0.003), and higher perceived satisfaction in QoL (p=0.04). Conclusions: The surgical approach elected to correct URF is not determinant of success nor of complications. Fistula size appears as independent determinant for failure. Transsphincteric approach could be advantageous over other procedures regarding HRQoL issues.

Profile of pharmaceutical care in primary health centers in São Bernardo do Campo, Southeastern Brazil

The effective insertion of the pharmacist into primary care is an important goal for health policies. The objective of this study was to describe and analyze pharmacists and Pharmaceutical Care in the primary health centers (UBS) of São Bernardo do Campo. Data were obtained through an interview applied to pharmacists. The instrument has three sections: (1) Pharmacist identification; (2) Pharmacist work; and (3) Pharmaceutical activities. Items in section 3 correspond to the guidelines of agencies that promote Pharmaceutical Care in the primary health system. All 24 pharmacists working in UBS in São Bernardo do Campo were interviewed. Every center dispensing medicines has a responsible pharmacist. These pharmacists are predominantly women and postgraduates. Activities of Pharmaceutical Care reported were: daily prescription analysis (75% of interviewees); monthly participation in patient groups (70.8%); monthly follow-up of pharmacotherapy adherence (58.3%); monthly participation in multiprofessional team meetings (54.2%); monthly home visits (12.5%); health education to the community (83.3%); and pharmacist consultation (37.5%). Frequency of prescription analysis and home visits was weakly associated with aspects of the pharmacist and the facility. This study showed that Pharmaceutical Services are structured in primary care in São Bernardo do Campo and many Pharmaceutical Care activities are offered in its UBS

Índice PROFUND y valoración global subjetiva. Valor pronóstico en pacientes pluripatológicos internados / PROFUND index and global subjective assessment. Prognostic value in hospitalized pluripathological patients

Resumen El índice PROFUND es una de las puntuaciones pronósticas sugeridas en pacientes pluripatológicos (PP). A pesar del valor pronóstico de la desnutrición y su prevalencia en esta población, el mismo no incluye una variable que estime el estado nutricional. La valoración global subjetiva (VGS) es una herramienta ampliamente validada para tal fin. Se evaluó mediante un estudio prospectivo y observacional, la capacidad pronóstica de mortalidad a 12 meses del índice PROFUND y VGS en PP internados en clínica médica. Ingresaron al estudio 111 pacientes. Edad 75.8 (± 9.3) años. Índice PROFUND 7.6 (± 4.7) puntos. El 60.1% presentaba desnutrición moderada-severa por VGS. Fallecieron 66 dentro del año. En el modelo de Cox, la VGS y el índice PROFUND se asocian con mortalidad a los 12 meses (p < 0.0001 y p 0.0026 respectivamente). En los desnutridos severos, el riesgo es aproximadamente 6 veces mayor en comparación a los normonutridos (HR: 6.514, IC95% 2.826-15.016) y para un mismo nivel de VGS, el riesgo es un 10% mayor por cada punto que aumenta el índice PROFUND (HR: 1.106, IC95% 1.036-1.181). El AUC para predecir mortalidad a 12 meses del índice PROFUND y VGS fue: 0.747 (IC95%: 0.656-0.838); 0.733 (IC95%: 0.651-0.816) y al combinar las dos variables: 0.788 (IC95%: 0.703-0.872, p 0.048). Como conclusión el índice PROFUND y la VGS se asocian con mortalidad y tienen un valor pronóstico similar. La combinación de ambas herramientas permitiría establecer mejor el pronóstico y el manejo en esta compleja población

Abstract The PROFUND index is one of the suggested prognostic scores in pluripathological patients (PP). Despite the prognostic value of malnutrition and its prevalence in this population, it does not include a variable that estimates nutritional status. Subjective global assessment (SGA) is a widely validated tool for this purpose. The prognostic capacity of 12-month mortality of PROFUND index and SGA in PP admitted to a medical clinic was evaluated by a prospective and observational study. 111 patients entered the study. Age 75.8 (± 9.3) years. PROFUND index 7.6 (± 4.7) points. 60.1% had moderate-severe malnutrition due to VGS. 66 died within the year. In the Cox model, SGA and PROFUND index are associated with mortality at 12 months (p <0.0001 and p 0.0026 respectively). In severe malnutrition, the risk is approximately 6 times higher compared to normonutrition (HR: 6.514, 95% CI 2.826-15.016) and for the same level of SGA, the risk is 10% higher for each point that the PROFUND index increases (HR: 1.106, 95% CI 1.036-1.181). The AUC for predicting 12-month mortality from PROFUND index and SGA was: 0.747 (95% CI: 0.656-0.838); 0.733 (95% CI: 0.651-0.816) and when combining the two variables: 0.788 (95% CI: 0.703-0.872, p 0.048). In conclusion, PROFUND index and SGA are associated with mortality and have a similar prognostic value. The combination of both tools would allow better prognosis and management in this complex population.

Análisis comparativo del Carcinoma Lobulillar Invasor versus Carcinoma Ductal Invasor: ¿entidades clínica o biológicamente diferentes? / Comparative analysis of Invasive Lobular Carcinoma versus Invasive Ductal Carcinoma: clinically or biologically different entities?

Introducción El Carcinoma Lobulillar Invasor (cli) es el tipo histológico especial más común del cáncer de mama. Presenta características histopatológicas asociadas a buen pronóstico, pero algunos estudios sugieren que los resultados a largo plazo pueden ser peores que los del Carcinoma Ductal Invasor (cdi). Objetivo Los objetivos principales del estudio fueron evaluar las características clínico-patológicas del cli y establecer el valor pronóstico. Material y método Se seleccionaron 244 pacientes con cli y se utilizó como grupo control a 524 pacientes con cdi, comparándolas con relación 2 a 1. Resultados No se observaron diferencias en edad, estado menopáusico, motivo de consulta e invasión linfovascular. Fueron más frecuentemente multifocales, multicéntricos, de mayor tamaño, bajo grado histológico y her2 negativo. La cirugía conservadora se realizó con menos frecuencia. No hubo diferencias significativas en recaída a distancia, cáncer de mama contralateral, sobrevida libre de enfermedad y global. Conclusiones Las pacientes con cli no tuvieron mejores resultados a pesar de un fenotipo biológico más favorable. La histología ductal o lobulillar no debería ser un factor en el manejo de la patología, y no debería considerarse un factor pronóstico o predictivo determinante al momento del diagnóstico

Introduction Invasive Lobular Carcinoma (ilc) is the second most common histologic type of breast cancer. Typically, displays features associated with a good prognosis, but some studies suggest that outcomes of ilc may be worse than for Invasive Ductal Carcinoma (idc). Objective The main purpose of this study was to evaluate the clinical-pathological characteristics of Lobular Breast Carcinoma and establish his prognostic value. Materials and method We selected a group of 244 patients with ilc and compared with 524 patients whit idc in relation 2:1. Results There were no differences in age, menopausal status, symptoms at time of diagnosis, and lymph vascular invasion. ilc were larger, low histological grade and her2 negative, more often mulfifocal and multicentric. Breast-preservation therapy was less frequent for Invasive Lobular Carcinoma. Distant relapse, contralateral cancer, overall survival, disease-free survival, did not differ between idc and ilc. Conclusions Women with ilc do not have better clinical outcomes than patients with idc, despite the fact that the biologic phenotype of ilc is quite favorable. The ductal or lobular histology should not be a factor in the therapeutic decision-making process, and should not be considered an important prognostic or predictive factor at diagnosis

Bullous systemic lupus erythematosus and membranous lupus nephritis in a Filipino child

@#<p style="text-align: justify;">Bullous eruptions are rare cutaneous manifestations of systemic lupus erythematosus. We report a case of an 8-year old Filipino girl with vesiculobullous systemic lupus erythematosus (SLE) and membranous lupus nephritis on kidney biopsy who presented with clinical nephrotic features of generalized edema, proteinuria, hypoalbuminemia and hyperlipidemia. The 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE were met. Immunohistopathologic examination of the skin lesion revealed a sub-epidermal split with neutrophilic infiltrates along the dermo-epidermal junction, moderate perivascular, periadnexal and interstitial infiltrates composed of predominantly neutrophils with neutrophilic dusts, lymphocytes, plasma cells, rare eosinophils and increased dermal mucin. Direct immunofluorescence showed strong continuous linear IgG deposits along the basement membrane and weak linear IgM and IgA deposition along the basement membrane zone (BMZ). To our knowledge, this is the first report of vesiculobullous SLE in a Filipino child. This case is a rare form of cutaneous lupus in children. Bullous SLE (BSLE) should be considered in the differential diagnosis of children presenting with generalized bullous eruptions.</p>

Validation of the EuroSCORE model in patients undergoing heart surgery in Regional Hospital of High Speciality of Bajio / Validación del modelo EuroSCORE en pacientes sometidos a cirugía cardiaca en el Hospital Regional de Alta Especialidad del Bajío

Abstract: Introduction: EuroSCORE is a probabilistic model with good performance in the prognosis of mortality in heart surgery in many latitudes. It is recommendable to validate it in hospitals where it is employed. Objective: To validate the EuroSCORE model in adult patients at the Hospital Regional de Alta Especialidad del Bajío (HRAEB) of León, Guanajuato, Mexico. Material and methods: We conducted an observational transversal, and retrospective study, accomplishing this through the review of the clinical files of patients submitted to heart surgery with and without extracorporeal circulation pump from 01/01/2008 to 12/31/2013 at the HRAEB. This included mortality up to hospital discharge, utilizing the on-line calculator of the EuroSCORE program to estimate risk of death. In order to validate the EuroSCORE model, we assessed discrimination and calibration through the Area Under the receiver operating characteristics (ROC) curve and χ2 test with Hosmer-Lemeshow (H-L) goodness-of-fit, respectively. Results: A total of 342 patients, aged 50.02 ± 16.66 years, 181 males (52.9%) and 161 women (47.1%). The area under the ROC curve of the additive model was 0.763, and of the Hosmer-Lemeshow test was 5.30, with p = 0.62. The area under the ROC curve of the logistic model was 0.761 and of the Hosmer-Lemeshow test, 8.78, with p = 0.36. Conclusion: The EuroSCORE model is a reliable score for estimating the probabilities of death in adult patients submitted to heart surgery with or without the pump at the HRAEB.

Resumen: Introducción: EuroSCORE es un modelo probabilístico con buen desempeño en el pronóstico de mortalidad en cirugía cardiaca en muchas latitudes. Es recomendable validarlo en los hospitales donde se emplea. Objetivo: Validar el modelo EuroSCORE en pacientes adultos en el Hospital Regional de Alta Especialidad del Bajío (HRAEB) de León, Guanajuato, México. Material y métodos: Se realizó un estudio observacional transversal y retrospectivo, que se completó con la revisión de los expedientes clínicos de pacientes sometidos a cirugía cardiaca con y sin bomba de circulación extracorpórea desde el 01/01/2008 hasta el 31/12/2013 en el HRAEB. Esto incluyó la mortalidad hasta el alta hospitalaria, utilizando la calculadora en línea del programa EuroSCORE para estimar el riesgo de muerte. Para validar el modelo EuroSCORE, evaluamos la discriminación y la calibración a través de la curva de características de operación del receptor (ROC) y la prueba de χ2 con la efectividad de ajuste de Hosmer-Lemeshow (H-L), respectivamente. Resultados: Un total de 342 pacientes, de 50.02 ± 16.66 años, 181 hombres (52.9%) y 161 mujeres (47.1%). El área bajo la curva ROC del modelo aditivo fue de 0.763, y la de la prueba Hosmer-Lemeshow fue de 5.30, con p = 0.62. El área bajo la curva ROC del modelo logístico fue 0.761 y de la prueba Hosmer-Lemeshow, 8.78, con p = 0.36. Conclusión: El modelo EuroSCORE es una herramienta confiable para estimar las probabilidades de muerte en pacientes adultos sometidos a cirugía cardiaca con o sin bomba en el HRAEB.

Diagnostic accuracy of Renal Angina Index in predicting Acute Kidney Injury in pediatric patients with Sepsis: A Philippine tertiary hospital experience

Background@#The coexistence of acute kidney injury (AKI) in sepsis contributes significantly to morbidity and mortality rates. Traditional diagnostic markers still pose variable limitations in early AKI prediction. The use of renal angina index (RAI) as a clinical predictive tool for AKI is an emerging concept.@*Objectives@#To determine the diagnostic accuracy of RAI in predicting AKI in patients with sepsis@*Methodology@#This is a five-year retrospective cohort study conducted at the Philippine General Hospital (PGH). Records of eligible patients with sepsis were reviewed. RAI was calculated based on the composite of risk factors and clinical evidence of injury on day 0 of admission stratifying subjects into two groups: RAI (-) and RAI (+) for those with scores ≥ 8. Prediction of AKI with the RAI was analyzed.

Chemical constituents from Bauhinia acuruana and their cytotoxicity

ABSTRACT Phytochemical investigation of Bauhinia acuruana Moric., Fabaceae, resulted in the isolation of sixteen constituents, including two new compounds 2'-hydroxy-2,3,5-trimethoxybibenzyl (1), (2R,3S)-2-(3,4'-dihydroxyphenyl)-5-methoxy-6-methylchroman-3,7-diol (2), together with fourteen known ones (3-16). The structures of the compounds were established by spectroscopic analysis including HR-ESI-MS, 1D and 2D NMR data, followed by comparison with previously reported data from the literature. Compounds 1, 2, 6, 7, 8 and 9 were evaluated for their cytotoxicity, which turned out to be marginal in a panel of six human cancer cell lines.

Quiste neuroentérico intradural: Reporte de un caso / Intradural neurenteric cysts. Case report

El quiste neuroentérico espinal es una lesión de rara presentación, sólo existen reportes de casos aislados. Representa del 0,3% al 1,3% de los tumores espinales según las distintas citas bibliográficas. Suele afectar el canal espinal, especialmente a nivel cervical bajo y torácico superior. Aproximadamente el 90% de estos quistes se localiza en el espacio intradural/ extramedular, mientras que el 10% restante se divide entre la localización intradural/intramedular o extradural. El tratamiento de los quistes neuroentéricos intraespinales es quirúrgico, mediante la resección lo más radical posible. Los resultados son favorables y las tasas de recurrencia después de la resección parcial son bajas. Nivel de Evidencia: IV

Spinal neurenteric cyst is a rare lesion, only anecdotal case reports have been published. The neurenteric cyst accounts for 0.3 to 1.3% of spinal axis tumors. It affects the inferior cervical and superior thoracic spine level. Approximately 90% of neurenteric cysts are located in the intradural/extramedullary compartment while the remaining10% are divided between an intradural/intramedullary or extradural location. Surgical intervention with radical resection is the best treatment. The outcome is favorable and the recurrence rates after partial resection are low. Level of Evidence: IV

Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus / Efeitos da abordagem terapêutica da persistência de canal arterial sobre a evolução neonatal de recém-nascidos de extremo baixo peso

OBJECTIVE: To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD. METHODS: This was a multicentric cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment), G2 - pharmacologic (indomethacin or ibuprofen), G3 - surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV. Outcomes: death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks. Statistics: Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significant. RESULTS: 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2 - 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) ...

OBJETIVO: Analisar os efeitos da terapêutica adotada para o canal arterial (CA) em recém-nascidos (RN) < 1.000gadmitidos em unidades neonatais (UN) da Rede Brasileira de Pesquisas Neonatais (RBPN), sobre os desfechos: óbito, displasia broncopulmonar (DBP), hemorragia intraventricular grave (HIVIII/IV), retinopatia da prematuridade cirúrgica (ROPcir), enterocolite necrosante cirúrgica (ECNcir) e o desfecho combinado óbito e DBP. MÉTODOS: Estudo multicêntrico, de coorte, coleta de dados retrospectiva, incluindo RN de 16 UN da RBPN de 01/01/2010 a 31/12/2011, PN < 1.000 g, idade gestacional (IG) < 33 semanas e diagnóstico ecocardiográfico de PCA. Excluídos: óbitos ou transferências até o terceiro dia de vida, infecções congênitas ou malformações. Grupos:G1 - conservadora (sem intervenção medicamentosa ou cirúrgica), G2 - farmacológica (indometacina ou ibuprofeno) e G3 - cirúrgico (com ou sem tratamento farmacológico anterior). Analisou-se: uso de esteroide antenatal, parto cesárea, PN, IG, Apgar5' < 4, sexo masculino, SNAPPE II, síndrome do dDesconforto respiratório (SDR), sepse tardia, ventilação mecânica (VM), surfactante < 2 horas de vida, tempo de VM e os desfechos: óbito, dependência de oxigênio com 36 semanas (DBP36s), HIV III/IV, ROPcir, ECNcir e óbito/DBP36s. Estatística: Teste t-Student, Qui-Quadrado ou teste Exato de Fisher. Testes de Regressão Binária Logística e Regressão Múltipla Stepwise Backward. MedCalc (Medical Calculator) software, versão 12.1.4.0.p < 0,05. RESULTADOS: Foram selecionados 1.097 RN e 494 foram incluídos: G1-187 (37,8%), G2-205 (41,5%) e G3-102 (20,6%). Verificou-se: maior mortalidade (51,3%) no G1 e menor no G3(14,7%); maior frequência DBP36s (70,6%) e ROPcir (23,5%) ...

Assessment and management of pediatric pain based on the opinions of health professionals

The present study characterized the opinions of health professionals about strategies for assessing and managing pediatric pain in a public teaching hospital. The sample consisted of 92 health professionals who worked in pediatric wards, pediatric intensive care, and neonatal intensive care. The sample included 45 doctors, 18 nurses, 16 psychologists, eight physiotherapists, and five occupational therapists. Data were collected through a self-administered questionnaire that included 22 open questions on the following topics: pain assessment, pharmacological management, and non-pharmacological interventions. Each area was analyzed with regard to actions, resources, gaps, and needs. The questionnaire was developed based on the principles of Strategic Planning. Two trained researchers analyzed the thematic content of all of the responses. With regard to actions and resources, 33% of the respondents mentioned the use of instruments for pain assessment, 73% reported that they prescribed pharmacological treatments for symptoms of pain, and 26% reported the use of non-pharmacological interventions for the relief of pain. The professionals predominantly reported a lack of training for pain assessment and management, standardized protocols, and human and material resources. Consequently, 96% of the professionals reported the necessity for educational training and standardized implementation guidelines for pain assessment services. These findings provide a baseline of the health professional's opinions of pain issues, which are essential for implementing and increasing pain assessment and management policies institutionally.

Resistencia antibiótica de streptococcus pneumoniae en portadores nasofaríngeos sanos de siete regiones del Perú / Antibiotic resistance of streptococcus pneumoniae among healthy nasopharyngeal carriers in seven regions of Peru

Objetivos. Determinar el patrón de susceptibilidad antibiótica de cepas de Streptococcus pneumoniae aisladas de portadores nasofaríngeos sanos menores de 2 años de siete regiones del Perú. Materiales y métodos. Entre el 2007 y 2009 se tomaron muestras de hisopado nasofaríngeo a 2123 niños sanos entre 2 y 24 meses de edad en los consultorios de crecimiento y desarrollo (CRED) y vacunación de hospitales y centros de salud de Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, e Iquitos. Se determinó la resistencia a diez antibióticos mediante la prueba de disco-difusión de las cepas de neumococo aisladas. Resultados. Se aislaron 572 cepas. Se encontró altas tasas de resistencia a cotrimoxazol (58%); penicilina (52,2% no-sensibles); tetraciclina (29,1%); azitromicina (28,9%), y eritromicina (26,3%). La resistencia a cloranfenicol fue baja (8,8%). Se encontró 29,5% de multirresistencia. La resistencia a la azitromicina y a la penicilina fue diferente en las siete regiones (p<0,05), hallándose el mayor porcentaje de cepas no-sensibles a penicilina en Arequipa (63,6%), mientras que el menor fue en Cusco (23,4%). Conclusiones. Los elevados niveles de resistencia encontrados para penicilina, cotrimoxazol y macrólidos en cepas de neumococo aisladas de portadores sanos en todas las regiones estudiadas, y su asociación con uso previo de antibióticos, representan un importante problema de salud pública en nuestro país. Esto resalta la necesidad de implementar, a nivel nacional, estrategias para disminuir el uso irracional de antibióticos, sobre todo en la población pediátrica. Es necesario complementar los datos de resistencia a penicilina con la determinación de la concentración mínima inhibitoria para hacer las recomendaciones terapéuticas respectivas.

Objectives. To determine the pattern of antibiotic susceptibility of isolated Streptococcus pneumoniae strains of healthy nasopharyngeal carriers younger than 2 years in seven regions of Peru. Materials and methods. Between 2007 and 2009, nasopharyngeal swab samples were collected among 2123 healthy children aged 2-24 months in growth and development medical practices (CRED) and vaccination offices of hospitals and health centers in Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, and Iquitos. The resistance to ten antibiotics through disk diffusion sensitivity testing of isolated pneumococcus strains was determined. Results. 572 strains were isolated. High rates of resistance to co-trimoxazole (58%), penicillin (52.2% non-sensitive); tetracycline (29,1%); azithromycin (28,9%), and erythromycin (26,3%). Resistance to chloramphenicol was low (8.8%). Multiresistance was found at 29.5%. Resistance to azithromycin and penicillin was different in all seven regions (p<0,05), the highest percentage of non-sensitive strains being found in Arequipa (63,6%), whereas the lowest percentage was found in Cusco (23.4%). Conclusions. High levels of resistance found to penicillin, co-trimoxasole and macrolides in isolated pneumococcus strains of healthy carriers in all studied regions, and their association to a previous use of antibiotics, represent a significant public health problem in our country. This emphasizes the need to implement nationwide strategies to reduce the irrational use of antibiotics, especially among children. It is necessary to complement data of resistance to penicillin with the determination of minimal inhibitory concentration to make proper therapeutic recommendations.

Response of oxygen saturation in preterm infants receiving rib cage stabilization with an elastic band in two body positions: a randomized clinical trial / Resposta da saturação de oxigênio no recém-nascido pré-termo com estabilização do gradil costal por meio da faixa elástica em duas posições corporais: ensaio clínico randomizado

BACKGROUND: Preterm newborns have higher thoracic compliance, providing less stability to the different forces of distortion imposed on the rib cage, leading to instability of the chest. Adequate body position may reduce this instability and facilitate respiratory work. OBJECTIVE: To assess the oxygen saturation response of preterm newborns receiving rib cage stabilization with an elastic band in two body positions. METHOD: A clinical, prospective, randomized crossover study was conducted, including sixteen newborns with a gestational age of 31 to 35 weeks (mean 32.8 weeks) at a tertiary care facility, who did not receive supplemental oxygen. The infants were placed in a sequence of prone and supine positions with and without chest stabilization with an elastic band. Respiratory rate, heart rate, and oxygen saturation were measured at 10-minute intervals, corresponding to 7 samplings of 60 minutes. Data collection was interrupted when oxygen saturation was less than 90%. RESULTS: The mean gestational age of the infants was 32.8±1.5 weeks and the mean birth weight was 1,789±255g. Better values for the variables studied were observed in the supine position with an elastic chest band compared to the supine position without the band. The positions using an elastic band resulted in lower mean respiratory rate and heart rate and higher oxygen saturation. CONCLUSION: The use of an elastic chest band improves respiratory indicators such as oxygen saturation. .

CONTEXTUALIZAÇÃO: Os recém-nascidos pré-termos possuem maior complacência torácica, oferecendo menor estabilidade às diferentes forças de distorção impostas à parede torácica, o que leva à instabilidade da caixa torácica. A posição corporal adequada pode diminuir essa instabilidade, facilitando o trabalho respiratório. OBJETIVO: Verificar a resposta da saturação de oxigênio em recém-nascido pré-termo com estabilização do gradil costal com faixa elástica em dois posicionamentos corporais. MÉTODO: Estudo com delineamento de ensaio clínico prospectivo, randomizado e tipo crossover. Foram avaliados 16 recém-nascidos com idade gestacional de 31 a 35 semanas (média 32,8 semanas) e sem oxigênio suplementar, em instituição de nível terciário. O grupo foi submetido à sequência de decúbitos posturais ventral e dorsal, alterando-os com e sem estabilização do tórax por meio da faixa elástica. Os indicadores biológicos colhidos foram frequência respiratória, frequência cardíaca e saturação de oxigênio. Os dados foram coletados de 10 em 10 minutos, totalizando 60 minutos com sete coletas. O critério de interrupção da coleta se deu pela saturação menor que 90%. RESULTADOS: O grupo estudado apresentou média de idade gestacional de 32,8±1,5 semanas e peso ao nascimento de 1.789±255g. Encontramos melhores valores das variáveis na supinação com faixa quando comparada com supinação sem faixa. Os valores médios menores da frequência respiratória e da frequência cardíaca foram alcançados no decúbito com faixa, já a saturação ...

14 year old male with oliguria and respiratory distress- What is your diagnosis?

@#A 14 year old male from Quezon City Manila was admitted due to oliguria. He presented with 7 days of intermittent fever associated with malaise, photophobia with redness of the eyes. A few hours before admission, he developed repetitive vomiting with decreased urine output. He denied any muscle pain, change in his sensorium or seizure episode. He had a history of wading in flooded waters.