Predictive accuracy of CURB-65 as comparedto PSI scorein the severity assessment of community acquired pneumonia

Introduction: Pneumonia Severity Index (PSI) and CURB-65 rule for community acquired pneumonia (CAP) have been developed to stratify patients based on mortality. Lack of a risk stratifying score like PSI or CURB-65 can lead to significant delay in starting treatment. This study was conducted to find out the ability of CURB-65 score and PSI to predict clinically relevant outcomes. Methods: 78 patients diagnosed as CAP admitted to a tertiary care hospital were enrolled into the study. Detailed clinical history was noted and CURB-65 and PSI scores were given with the help of a structured questionnaire in <24 hours of admission. The patients were revisited at day 3 and at discharge and data collected. Results:Out of 78 patients included in the study, 60 were males and 18 were females. Of the 78 patients, 14 died accounting for aninhospital mortality of 17.94%. Mortality in the mild, moderate and severe groups of CURB-65 were 0%, 16.7% and 47.8% respectively. Mortality in the mild, moderate and severe groups of PSI were 1.8%, 50% and 80% respectively. Area under the curve (AUC) for CURB-65 and PSI in terms of inhospital mortality were 0.935 and 0.920 respectively. Conclusion:The CURB-65 and PSI scores correlated well with mortality and other severity indicators. The CURB-65 has a better discriminatory power than PSI inour study. Because of its simplicity in addition to its better discriminatory power than PSI, CURB-65 may be better suited as a severity scoring system in CAP.

Efeito da fibra de coprodutos agroindustriais e sua avaliação nutricional para coelhos / Effect of agricultural by-products fiber and its nutritional evaluation for rabbits

Estudou-se a influência da fibra oriunda de diferentes fontes - feno de alfafa, polpa de cítrus e casca de soja - sobre o desempenho, coeficientes de digestibilidade, parâmetros sanguíneos e características da carne de coelhos submetidos às dietas experimentais. Os animais foram distribuídos em três tratamentos, que consistiram de: FA - ração-controle, com feno de alfafa; PC - substituição total do feno de alfafa por polpa de cítrus; e CS - substituição total do feno de alfafa por casca de soja. As diferentes frações da fibra advindas da polpa de cítrus e da casca de soja não influenciaram o desempenho dos animais aos 89 dias e mostram que esses ingredientes podem ser utilizados como substitutos do feno de alfafa na dieta de coelhos. A qualidade de fibra da polpa de cítrus reduziu os níveis séricos de triacilglicerol, colesterol e hemoglobina dos animais. A baixa quantidade de lignina em relação à celulose e à hemicelulose da casca de soja propiciou melhor coeficiente de digestibilidade dos nutrientes e maior maciez da carne, porém menor deposição proteica quando comparada com a dieta com polpa de cítrus.

The influence of fiber - alfalfa hay, citrus pulp, and soybean hulls - in diets of rabbits was studied on performance, digestibility coefficients, blood parameters, and meat characteristics. The animals were allotted into three treatments that consisted in: control diet, with alfalfa hay; total substitution of alfalfa hay by citrus pulp; and total substitution of alfalfa hay by soybean hulls. The different fiber fractions from citrus pulp and soybean hulls did not affect animal performance at the 89th day; thus, these ingredients can be used as substitute of alfalfa hay on diet of rabbits. Fiber quality of citrus pulp decreased blood triacylglycerol, cholesterol, and hemoglobin levels. Lower amount of lignin in relation to cellulose and hemicellulose of soybean hulls provided better nutrient digestibility coefficients and higher tenderness meat, however, lower protein deposition when compared with the citrus pulp diet.

Clinical features and surgical outcome of patients with indolent brain tumors and epilepsy

INTRODUCTION: In this study the authors review the outcomes of 22 patients with medically refractory epilepsy and slow growth brain tumors. OBJECTIVES: Evaluate the clinical, electrophysiological, operative, and histopathological features. PATIENTS AND RESULTS: The majority of the tumors were located in the temporal lobe (n = 20) and involved the cortical gray matter. The most frequent tumors were gangliogliomas (n = 9), astrocytomas grade I and II (n = 6), dysembryoplastic neuroepithelial tumors (n = 5) and ganglioneuroma (n = 2). The biological behavior of the tumors was strikingly indolent, as indicated by a long preoperative history of chronic seizures (mean, 14 years). Mean follow-up time after resection was 27 months, and according to EngelÆs classification, 85 percent were seizure-free, 10 percent showed a reduction of seizure frequency of at least 90 percent, and 5 percent had reduction in seizure frequency at least 75 percent. CONCLUSION: The data indicate that neoplasms associated with pharmacoresistent epilepsy constitute a distinct clinicopathological group of tumors that arise in young patients, involve the cortex, and exhibit indolent biological behavior for many years. Complete surgical removal of these tumors, including the epileptogenic area, can achieve excellent seizure control.

INTRODUÇÃO: Neste estudo os autores avaliaram retrospectivamente 22 pacientes tratados cirurgicamente com diagnóstico de epilepsia refratária e tumor cerebral de crescimento lento. OBJETIVOS: Avaliar os aspectos clínicos, eletrofisiológicos, cirúrgicos e histopatológicos. PACIENTES E RESULTADOS: A maioria dos tumores estava localizada no lobo temporal (n = 20) com envolvimento da substância cinzenta. Ganglioglioma foi o tumor mais frequente (n = 9), seguido do astrocitoma grau I e II OMS (n = 6), tumor neuroepitelial disembrioplástico (DNET) (n = 5) e ganglioneuroma (n = 2). O comportamento biológico dos tumores foi estritamente indolente como indicado pela longa história pré-operatória de (média, 14 anos). O tempo de acompanhamento pós-operatório médio foi de 27 meses e de acordo com a Classificacão de Engel, 85 por cento ficaram sem crises (Classe I), 10 por cento obtiveram redução maior de 90 por cento das crises (Classe II), e 5 por cento tiveram redução menor que 75 por cento (Classe III). CONCLUSÃO: Os dados indicam que neoplasias associadas à epilepsia crônica refratária constituem um grupo de tumores com características clinico-patológicas distintas que se iniciam em pacientes jovens, envolvem o córtex e apresentam comportamento biológico indolente. A ressecção cirúrgica completa destes tumores, incluindo a zona epileptogênica, levou ao controle total das crises na maior parte dos casos estudados.

Knowledge, Attitudes, and Practices Survey of Rabies in a Community in Sri Lanka

Objectives: The primary objective of this study was to determine the level of knowledge, attitudes and practices (KAP) of rabies management and control of a sample population. The secondary objective was to compare the KAP with respect to rabies management and control between urban and rural areas and between pet and non-pet owners. Methods: This cross-sectional study was carried out by conducting face-to-face interviews using structured questionnaires among 1570 respondents from selected households in the Kandy District, Sri Lanka. Results: Approximately 58% of the sample population was pet owners. Among all the respondents, there was a high level of awareness (90%) that dogs are the most common rabies reservoir, that the disease is fatal (79%), and that rabies can be prevented by vaccination (88%). Most of the subjects (96%) would seek treatment from a doctor or a hospital after being bitten by a dog. Although 76% of the respondents said that their pet dogs were vaccinated, only one-half were able to present a vaccination certificate upon request. The subjects from the urban areas would submit the head of an animal for rabies evaluation (69%) compared with those from the rural areas (57%). Pet owners (93%) are more aware that dog rabies vaccines are available from authorized offices than non-pet owners (87%). Conclusions: The level of awareness of rabies and the level of receptiveness to rabies control measures are high. There is a difference in the attitudes and pet care practices relevant to rabies control between urban and rural areas. Pet owners tend to be more cooperative to rabies control activities. The attitudes and practices of the respondents may reflect the inaccessibility of facilities and the lack of services that would enable community participation in rabies control.

Neoplasias associadas ao carcinoma epidermóide do esôfago / Neoplasms associated to esophageal epidermoid carcinoma

INTRODUÇÄO. O carcinoma epidermóide de esôfago (CEE) tem uma importante associaçäo com neoplasias do trato aerodigestivo e, provavelmente, compartilham dos mesmos fatores de risco. Além destes, outras neoplasias podem estar associadas com o carcinoma de esôfago. OBJETIVO. Analisar, retrospectivamente, pacientes com carcinoma epidermóide de esôfago tratados pelo Grupo de Cirurgia do Esôfago, Estômago e Intestino Delgado (GCEEID) do Hospital de Clínicas de Porto Alegre (HCPA), no período de janeiro/88 a junho/95, os quais tinham neoplasias associadas ao CEE. PACIENTES E MÉTODOS. Dentre os 261 pacientes estudados, 19 (7,28 por cento) tinham neoplasia associada ao CEE. Dez pacientes apresentaram tumores sincrônicos e 9, metacrônicos. O sexo predominante foi o masculino, com 17 casos. A média de idade ficou em 62,52 anos no momento do diagnóstico da neoplasia esofágica. RESULTADOS. Os tumores aerodigestivos, na sua totalidade carcinomas escamosos, representaram o tipo histológico predominante da neoplasia associada em 68,42 por cento dos casos. O sítio mais freqüente da neoplasia aerodigestiva associada foi a árvore respiratória (53,8 por cento), seguido da cavidade oral e orofaringe (23 por cento) e laringe (23 por cento). Dos 19 pacientes, 12 eram tabagistas e nove ingeriam bebidas alcoólicas regularmente. Para o tratamento do CEE, optou-se por cirurgia em seis pacientes. A neoplasia associada foi tratada com cirurgia radical em 11 pacientes e radioterapia em cinco. Surpreendentemente, foram diagnosticados quatro casos (21 por cento) de adenocarcinomas gßstricos associados ao CEE, tratados com cirurgia radical em três pacientes. CONCLUSÄO. Os autores ressaltam a importância do estadiamento criterioso dos pacientes com CEE devido a associaçäo significativa com outras neoplasias, principalmente com tumores aerodigestivos. Alertam para o seguimento desses pacientes e discutem a possibilidade de fatores de risco comuns: fumo e álcool. Nesta casuística, encontrou-se associaçäo importante com neoplasias gástricas.