ABSTRACT
Objetivos: Proporcionar guías de traqueostomía para el paciente crítico, basadas en la evidencia científica disponible, y facilitar la identificación de áreas en las cuales se requieren mayores estudios. Métodos: Un grupo de trabajo formado con representantes de 10 países pertenecientes a la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva y a la Latin American Critical Care Trial Investigators Network(LACCTIN) desarrollaron estas recomendaciones basadas en el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: El grupo identificó 23 preguntas relevantes entre las 87 preguntas planteadas inicialmente. En la búsqueda inicial de la literatura se identificaron 333 estudios, de los cuales se escogieron un total de 226. El equipo de trabajo generó un total de 19 recomendaciones: 10 positivas (1B = 3, 2C = 3, 2D = 4) y 9 negativas (1B = 8, 2C = 1). En 6 ocasiones no se pudieron establecer recomendaciones. Conclusión: La traqueostomía percutánea se asocia a menor riesgo de infecciones en comparación con la traqueostomía quirúrgica. La traqueostomía precoz solo parece reducir la duración de la ventilación mecánica pero no la incidencia de neumonía, la duración de la estancia hospitalaria o la mortalidad a largo plazo. La evidencia no apoya el uso de broncoscopia de forma rutinaria ni el uso de máscara laríngea durante el procedimiento. Finalmente, el entrenamiento adecuado previo es tanto o más importante que la técnica utilizada para disminuir las complicaciones.(AU)
OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.(AU)
Subject(s)
Humans , Spinal Cord Injuries/rehabilitation , Critical Care/methods , Respiration, Artificial , Time Factors , Bronchoscopy , Tracheostomy , Laryngeal Masks , Length of StayABSTRACT
ABSTRACT Protium heptaphyllum is found in the Amazon region, and in various Brazilian states and South American countries. Also Known as almecega, it produces an oil resin used in traditional medicine as analgesic, anti-inflammatory, cicatrizant and expectorant, it is rich in pentacyclic triterpenes and essential oil. The main objective of this study was to analyze the chemical composition of P. heptaphyllumresin (OEPh) over different extraction times and to evaluate their antifungal activity against Candida species, obtained from gardeners with onychomycosis, using the disk diffusion method. The OEPh was obtained by hydrodistillation and analyzed by Multidimensional Gas Chromatography coupled with Mass Spectrometry (MDGC / MS). Candida species were obtained from lesions on the nails of horticulturist from a community garden in the city of Teresina, Piauí, Brazil. The antifungal activity in concentrations of 1000 µg/L, 500 µg/L and 250 µg/L, PROTOCOL M44-A2 (CLSI 2009) OEPh was tested. The main constituents identified were: l-limonene, α-terpineol, p-cineol, o-cymene and α-phellandrene, however, its composition varies significantly with extraction time. All species, except C. rugosa, were inhibited with halo (≥ 14 mm) at 1000 μg / L. C. krusei is naturally resistant to the drug fluconazole, but when tested with OEPh the clinical species (case 9) demonstrated sensitivity in three dilutions (halo ≤ 10 ≥ 14) and the standard strain was inhibited at concentration of 1000 μg/Lg / L (halo 14mm). A similar situation also occurred with the standard strain of C. parapsilosis (halo ≥ 11mm). OEPh has considerable antifungal activity, which merits further investigation for alternative clinical applications, since this species is widely distributed in our community, and it presents good yields, and also has important therapeutic applications.
RESUMO Protium heptaphyllum é encontrada na região amazônica, em vários estados do Brasil e países da América do Sul. Conhecida como almecega produz uma resina oleosa usada na medicina popular como analgésica, antiinflamatória, cicatrizante e expectorante, é rica em triterpenos pentaciclicos e óleo essencial. O objetivo principal do presente trabalho foi analisar a composição química do óleo essencial da resina P. heptaphyllum (OEPh) em diferentes tempo de extração e avaliarsuaatividade antifúngica contra espécies de Candida, isoladas de horticultores com onicomicoses, por método de disco-difusão. O OEPh foi obtido por hidrodestilação, analisado por Cromatografia Gasosa Multidimensinal Acoplada a Espectrometria de Massas (MDGC/MS). As espécies de Candida foram obtidas de lesões nas unhas de horticultores de uma horta comunitária na cidade de Teresina, Piauí, Brasil. Testou-se a atividade antifúngica do OEPhnas concentrações de 1000 μg/L, 500 μg/L e 250 μg/L, protocolo M44-A2 (CLSI 2009). Os principais constituintes identificados foram l- limoneno, α-terpineol, p-cineol, o-cimeno e α-felandreno, entretanto, sua composição varia significativamente em decorrência do tempo de extração. Todas as espécies, exceto a C. rugosa, foram inibidas com halo ( Χ ≥ 14 mm) na concentração de 1000 μg/L. C. krusei é naturalmente resistente ao fármaco fluconazol, mas quando testado com OEPh,a espécie clínico (caso 9) demonstrou sensibilidade nas três diluições (halo Χ ≤ 10 ≥ 14) e a cepa padrão foi inibida na concentração de 1000 μg/L (halo Χ 14mm). Fato semelhante também ocorreu com a cepa padrão de C. parapsilosis (halo Χ ≥ 11mm). O OEPh possui atividade antifúngica considerável, merecendo uma investigação mais aprofundada para aplicações clínicas alternativas, uma vez que esta espécie é amplamente distribuída em nossa comunidade, apresenta bom rendimento e, ainda, aplicações terapêuticas importantes.
Subject(s)
Candida/classification , Oils, Volatile/analysis , Burseraceae/chemistry , /analysis , Onychomycosis/diagnosis , Disease Susceptibility/classificationABSTRACT
De outubro a dezembro de 2007, 845 amostras de sangue foram coletadas de 836 vacas (98,9%) e nove touros (1,1%), em um matadouro com inspeção federal no Estado do Tocantins. Cento e quarenta e duas amostras [(16,8%) IC 95% 14,3-19,4] tiveram reação positiva ao teste do antígeno acidificado e tamponado de Brucella abortus. Um touro foi positivo ao teste. Quinhentos e sessenta e um bovinos (66,3%) procederam do Estado do Pará e 284 (33,7%) do Estado do Tocantins. A prevalência de soropositividade foi de 17,2% [IC (95%) 13,6 - 19,9] e de 16,6% [IC (95%) 13,0 - 22,2] para o gado do Pará e Tocantins, respectivamente. Estas prevalências não são significativamente diferentes (p > 0,05). Nenhuma das vacas tinha registro de vacinação contra brucelose. Os exames "ante e post-mortem" não detectaram qualquer sinal ou lesão sugestiva à brucelose, como descargas vaginais, orquites, artrites ou bursites [(0,00%) IC 95% 0,00-0,43] em todos os bovinos da amostra. Esta situação, associada às altas prevalências da doença e à falta de diagnóstico da brucelose nos rebanhos, aumenta o número de bovinos infectados abatidos sob condições sanitárias inadequadas, o risco de contaminação dos trabalhadores e a colocação no mercado, sem restrição, de carne de animais infectados.
From October to December 2007, 845 blood samples were collected from 836 cows (98.9%) and nine bulls (1.1%), in a slaughterhouse with federal inspection in the state of Tocantins. One hundred and forty-two samples [(16.8%) 95% CI 14.3-19.4] had positive reaction to the plate agglutination test carried out with acidified and buffered antigen of Brucella abortus. One bull was positive to the test. Five hundred and sixty one bovines came from the State of Pará (66.3%) and 284 (33.7%) came from the State of Tocantins. The prevalence of serum positivity was 17.2% [CI (95%) 13.6 19.9] and 16.6% [CI (95%) 13.0 22.2] for cattle came from Pará and Tocantins, respectively, with no significant difference between these frequencies (p > 0.05). None of the cows had record of vaccination against brucellosis. "Ante and post-mortem" examinations could not find any sign or lesion attributable to brucellosis, such as vaginal discharges, joint inflammation or bursitis [(0.00%) 95% CI 0.00-0.43] in all bovines sampled. This situation, coupled with the high prevalence of the disease and the lack of brucellosis diagnostic at herds, increases the number of infected cattle slaughtered under inadequate sanitary conditions, the risk of contamination of workers and placing on the market, without restriction, the meat from infected animals.