Impact of the lactate dehydrogenase in association with the International Staging System prognostic score in multiple myeloma patients treated in real life

Abstract Introduction Multiple myeloma is characterized by proliferation of clonal plasma cells. The identification of prognostics factors to identify patient's risk is important. Among the studied factors, it was identified of relevant importance the lactic dehydrogenase. Objectives To evaluate the impact of the value of DHL in combination with the score ISS in the medium patients overall survival (OS). Methods It is a retrospective cohort with 252 patients with MM recently-diagnosed that attendance in the institution of the study. Results To evaluate the association between DHL and ISS, we found 6 new groups to be analyzed: ISS I and normal DHL with medium overall survival not reached, and with DHL loud with medium OS of 69,8 months, ISS II and normal DHL with medium overall survival of 78,8 months and with DHL loud with medium OS of 73,9 months, ISS III and normal DHL with medium overall survival of 46,7 months and with DHL loud with medium OS of 45,5 months. Conclusion Through the association of ISS I and normal DHL, ISS III and high DHL and others combinations, we build a new score with superior impact prognostic in our population treated in real life.

Validation of the prognostic value of the Mayo MASS and R2-ISS staging systems in patients newly diagnosed with multiple myeloma: A single-center study / 中华血液学杂志

Objective: To evaluate the prognostic value of Mayo MASS and R2-ISS staging systems in patients newly diagnosed with multiple myeloma (MM) . Methods: A total of 371 patients newly diagnosed with MM in Jiangsu Province Hospital were included in the study. Cytoplasmic light chain immunofluorescence with fluorescence in situ hybridization (cIg-FISH) was performed to detect cytogenetic abnormality. Clinical characteristics were combined to analyze the disease stage and evaluate the prognosis. Results: There were 37 (10.0%), 264 (71.0%), and 70 (18.8%) patients in R-ISS stage Ⅰ, Ⅱ, and Ⅲ, respectively. The median progression-free survival (PFS) times were 37, 25, and 14 months (P<0.001). The median overall survival (OS) times were not reached (NR), 66, and 30 months (P<0.001). There were 71 (19.1%), 140 (37.7%), and 160 (43.2%) patients in Mayo MASS stages Ⅰ, Ⅱ, and Ⅲ, and the median PFS times periods were 43, 27, and 19 months (P<0.001), and the median OS times were NR, NR, 35 months, respectively (P<0.001). There were, 23 (6.2%), 69 (18.6%), 222 (59.8%), and 57 (15.4%) patients in R2-ISS stages Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. The median PFS times were 47, 31, 25, and 15 months (P=0.001), and the median OS times were NR, NR, 49, and 55 months, respectively (P<0.001) . Conclusion: Based on the R-ISS staging system, Mayo MASS, and R2-ISS prognostic staging system incorporated 1q21+, which allows a better stratification. However, the proportion of stage Ⅲ patients in Mayo MASS and R2-ISS staging systems is relatively high, which is considered related to the high incidence of 1q21+ and ISS Ⅲ in the Chinese population.

La doble heterocigosis por la mutación común en el codón 39 (C>T) (ß0) y la deleción siciliana (δß0) 13.4 kb causa una beta-talasemia transfusión dependiente en dos pacientes costarricenses / (Double heterozygosity for the common mutation at codon 39 (C>T) (ß0) and the Sicilian (δß0) 13.4 kb deletion, causes transfusiondependent beta-thalassemia in two Costa Rican patients)

Las talasemias son desórdenes autosómicos recesivos de las cadenas de hemoglobina que poseen expresión clínica variable según el tipo de mutación o deleción. Presentamos el caso de dos jóvenes mujeres costarricenses no relacionadas entre sí y ambas diagnosticadas con la mutación común en el codón 39 (C>T) (β0) en combinación con la deleción siciliana (δβ0) 13.4 kb. La caracterización de doble heterocigota no había sido descrita antes en la literatura médica, y discutimos el significado de este genotipo que causa un defecto tipo β0 talasemia transfusión dependiente.

Thalassemia are autosomal recessive disorders of hemoglobin chains with variable clinical expression depending on the type of mutation or deletion present. We present the common codon 39(C>T) (β0) in combination with the δβ0 13.4 kb Sicilian deletion in two non-related young women from Costa Rica. We report the characterization of the compound heterozygous not previously described phenotype, and discuss the significance of this genotype combination with a transfusion dependent β0 defect Thalassemia.

Correlation of body mass index to Ghrelin and IGF-1 among children with short stature

Abstract Objective: To assess the BMI among children with Growth Hormone Deficiency (GHD) and Idiopathic Short Stature (ISS) and its correlation to ghrelin, Growth Hormone (GH), and Insulin-like Growth Factor-1 (IGF-1) levels. Methods: A cross-sectional descriptive study in which 42 patients attending the Pediatric endocrine clinic were enrolled, allocated into two groups: group I: GHD children; group II: ISS children. Ghrelin, IGF-1 and GH in both groups were measured. Results: Ghrelin was significantly higher among GHD group (p < 0.001). Overall, there was a strong negative correlation between IGF-1 and ghrelin (r = -0.977, p-value = < 0.001) while a moderate positive correlation between ghrelin and BMI (r = 0.419, p-value = 0.006). There was a weak positive non-significant correlation between IGF-1 and BMI (r = 0.276, p-value = 0.077). In GHD group, there was a weak positive non-significant correlation between ghrelin and GHmax measurement (r = 0.052, p-value = 0.824), while a weak negative non-significant correlation between both variables in ISS group (r = -0.243, p-value = 0.288). In GHD group, there was a moderate positive correlation between ghrelin and BMI (r = 0.500, p-value = 0.021), but weak negative non-significant correlation between both variables in ISS group (r = -0.255, p-value = 0.265). Conclusion: There was a negative feedback loop between ghrelin and IGF-1, whereas a positive feedback between ghrelin and BMI. BMI was more affected in the ISS group but was non-signifi-cantly correlated with ghrelin. There was no significant compensatory response of ghrelin suggesting its contribution to the pathogenesis of ISS.

The Role of Whole Body DWI in the Evaluation of Bone Disease in Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To explore the characteristics of ADC value changes in DWI of newly diagnosed symptomatic MM patients and its correlation with R-ISS stage.@*METHODS@#The data of 148 newly diagnosed symptomatic MM patients treated by whole-body DWI scan at The First Affiliated Hospital of Soochow University from June 2016 to June 2019 were selected and retrospectively analyzed and 30 cases of age-matched healthy people were selected as controls. The differences of ADC values between the patients in normal control group, DWI- group and DWI+ group were compared, and the relationship between ADC values and R-ISS stage in MM patients was compared.@*RESULTS@#The plasma cell percentage of the patients in DWI+ group was higher than those in DWI- group. ADC values of vertebra, sternum, rib, pectoral girdle, pelvic girdle of the patients in DWI+ group were significantly higher than those in DWI- group and normal control group. The ADC values of each part of the patients in DWI- group were higher than those in normal control group. ADC values of sternum, rib and pectoral girdle in the patients at R-ISS stage III were higher than those at R-ISS stage I and II, while, there was no statistical difference between R-ISS stage I and II groups. And there was no significant difference in ADC values of other bone parts such as vertebra and pelvic girdle in patients at R-ISS stage Ⅰ-Ⅲ.@*CONCLUSION@#DWI+ in MM patients is related to higher tumor invasion. The ADC values of the DWI+ group are higher than those of the DWI- group; the bone ADC values of the DWI- patients are still higher than the normal ones. And there is a certain relationship between ADC value and R-ISS stage.

Initial Prealbumin Level And Ability To Normalize Prealbumin Are Highly Predictive Of Increased Mortality And Morbidity In Elderly Trauma Patients

Prealbumin is a well characterized indicator of nutritional status more recently found to be an inverse inammatory marker. At our urban level 1 trauma center, we sought to study the relationship between malnutrition and outcomes in elderly trauma patients. Using prealbumin as a surrogate marker for nutritional status, we hypothesized that patients with reduced prealbumin on initial evaluation have worse outcomes, and in patients where initial prealbumin that was reduced, ability to correct is associated with improved outcomes. We performed a retrospective cohort study involving 200 consecutive patients over the age of 65 admitted to our trauma service. Based on initial prealbumin, patients were divided into 3 groups - below 5 mg/dL, 5-10 mg/dLand greater than 10 mg/dL. Prealbumin was then re-assessed 4 days after admission and patients were again divided into 2 groups based on ability to normalize prealbumin. Data obtained included age, gender, revised trauma score (RTS), injury severity score (ISS), days on a ventilator, ICU length of stay (ICU-LOS), hospital length of stay (HLOS), survival, initial prealbumin, and ability to correct prealbumin within 4 days after admission. Of the 200 patients enrolled, patients were divided into 3 groups using initial prealbumin - 71 patients below 5 mg/dL, 101 patients 5-10 mg/dL, and 28 patients greater than 10 mg/dL. There were 180 patients who were hospitalized for over a 4 day period. Normalization of prealbumin was achieved in 128 patients while 52 patients did not. Mean age was 79.2 years. RTS was found to be decreased in patients with initial prealbumin below 5 mg/dLin comparison to the other groups (11.3 vs. 11.8 vs. 11.8, p = 0.0002), with greater ISS (25.1 vs. 18.8 vs. 19.7, p < 0.0001), ICU LOS (days) (11.3 vs. 3.9 vs. 3.0, p < 0.0001), ventilator days (7.9 vs. 0.8 vs. 0.1, p < 0.0001), HLOS (days) (17.4 vs 7.8 vs. 7.1, p < 0.0001) and decreased survival (66% vs. 95% vs. 100%, p < 0.0001). Patients with prealbumin corrected within 4 days had lower ISS (19.9 vs. 29.2, p < 0.0001), as well as reduction in ventilator days (0.9 vs. 10.1, p < 0.0001), ICU LOS (days) (4.2 vs. 13.8, p < 0.0001), HLOS (days) (8.3 vs. 21.3, p < 0.0001) and improved survival (94% vs. 63%, p < 0.0001). Prealbumin is able to provide short term information regarding current nutritional status and response to therapy. Recent evidence suggest prealbumin may be a prognostic indicator for risk of malnutrition and inammation in critically ill trauma patients. In management of critically ill trauma patients, prealbumin can provide a valuable clinical indication of response to therapeutic intervention and potentially guide management strategy.

Adverse effects of double-hit combining ISS-Ⅲ stage and 1q gain or del (17p) on prognosis of patients with newly diagnosed multiple myeloma / 中华血液学杂志

Objective@#To evaluate the prognostic significance of combining ISS-Ⅲ and high risk cytogenetic abnormalities [HRCAs, including 1q gain/amplification and del (17p) ] in patients with newly-diagnosed multiple myeloma (NDMM) .@*Methods@#The clinical characteristics and relevant variables were retrospectively analyzed in a total of 270 NDMM patients diagnosed between November 2009 and May 2018. ISS-Ⅲ stage and HRCAs [detected by FISH, including 1q gain/amplification and del (17p) ] were defined as risk factors (hit) . Based to the number of hit per case, these patients were divided into four groups carrying 0 to 3 risk factors, respectively. Progress-free survival (PFS) and overall survival (OS) were then analyzed using the Kaplan-Meier estimator.@*Results@#Patients who carried single hit (n=120, 44.4%) had shorter median PFS (23.0 vs 28.9 months; P>0.05) and OS (42.3 vs 53.7 months; P>0.05) than those with no risk factors (n=66, 24.4%) . Of note, the outcome of patients who had two or more risk factors (double/triple, n=84, 31.1%) was much worse than those with either no or one risk factor, indicated by significantly reduced median PFS (14.5 months; HR=1.584, 95%CI 1.082-2.319; P=0.003 for double/triple vs single hit) and OS (18.4 months, HR=2.299, 95%CI 1.485-3.560; P<0.001 for double/triple vs single hit) . Strikingly, patients who had three risk factor (triple hit, n=5, 1.9%) displayed the poorest survival with extraordinarily shorter PFS (0.9-15.1 months) and OS (0.9-18.9 months) compared to those carrying two risk factors (double hit) . Analogous results were obtained when different combinations of ISS stages and HRCAs were analyzed.@*Conclusion@#These results suggest a potential but rather important role of combining multiple (e.g. double or triple) adverse factors determined via the routine ISS staging and FISH detection of cytogenetic abnormalities in risk stratification and prognostic prediction, which might be helpful to identify high risk patients more precisely at diagnosis. It also raised a possibility that a small group of ISS-Ⅲ patients carrying both 1q gain/amplification and del (17p) might represent an "extremely-high risk" subset of MM.

Adverse effects of double-hit combining ISS-Ⅲ stage and 1q gain or del (17p) on prognosis of patients with newly diagnosed multiple myeloma / 中华血液学杂志

Objective: To evaluate the prognostic significance of combining ISS-Ⅲ and high risk cytogenetic abnormalities [HRCAs, including 1q gain/amplification and del (17p) ] in patients with newly-diagnosed multiple myeloma (NDMM) . Methods: The clinical characteristics and relevant variables were retrospectively analyzed in a total of 270 NDMM patients diagnosed between November 2009 and May 2018. ISS-Ⅲ stage and HRCAs [detected by FISH, including 1q gain/amplification and del (17p) ] were defined as risk factors (hit) . Based to the number of hit per case, these patients were divided into four groups carrying 0 to 3 risk factors, respectively. Progress-free survival (PFS) and overall survival (OS) were then analyzed using the Kaplan-Meier estimator. Results: Patients who carried single hit (n=120, 44.4%) had shorter median PFS (23.0 vs 28.9 months; P>0.05) and OS (42.3 vs 53.7 months; P>0.05) than those with no risk factors (n=66, 24.4%) . Of note, the outcome of patients who had two or more risk factors (double/triple, n=84, 31.1%) was much worse than those with either no or one risk factor, indicated by significantly reduced median PFS (14.5 months; HR=1.584, 95%CI 1.082-2.319; P=0.003 for double/triple vs single hit) and OS (18.4 months, HR=2.299, 95%CI 1.485-3.560; P<0.001 for double/triple vs single hit) . Strikingly, patients who had three risk factor (triple hit, n=5, 1.9%) displayed the poorest survival with extraordinarily shorter PFS (0.9-15.1 months) and OS (0.9-18.9 months) compared to those carrying two risk factors (double hit) . Analogous results were obtained when different combinations of ISS stages and HRCAs were analyzed. Conclusion: These results suggest a potential but rather important role of combining multiple (e.g. double or triple) adverse factors determined via the routine ISS staging and FISH detection of cytogenetic abnormalities in risk stratification and prognostic prediction, which might be helpful to identify high risk patients more precisely at diagnosis. It also raised a possibility that a small group of ISS-Ⅲ patients carrying both 1q gain/amplification and del (17p) might represent an "extremely-high risk" subset of MM.

Prognosis-related factors of severe trauma in intensive care unit / 中华急诊医学杂志

Objective To evaluate the prognosis-related factors of severe trauma in Intensive Care Unit,and to provide clinical reference for the diagnosis and treatment of severe trauma.Methods The clinical data of all 408 patients with severe trauma and ISS score ≥ 25 admitting to our ICU and from January 2011 to December 2015 were retrospectively analyzed.To summarize the epidemiological characteristics and compare gender,age,site of injury,cause of injury,duration,complications,treatment,ISS score and APACHE Ⅱ score between the improved group and the death or deterioration group.Results There were 332 people who were improved and 76 people who died or deteriorated.The patients of death and deterioration groups were older,has a higher proportion of self falls,environment disorder,shock,ARF,ARDS and MODS,more complications,and are more likely to accept mechanical ventilation,blood purification,CPR and lower GCS score and higher APACHE Ⅱ score.The improvement group has more sites of injury higher proportion of chest,limbs and pelvis injury,and is more likely to accept surgical operation and the longer hospital stay.Binary Logistic regression analysis shows that age ＞ 55,self falls,MODS,APACHE Ⅱ ＞ 20 and CPR are risk factors of death and deterioration for the severe trauma in ICU.Conclusion It's essential to pay more attention to the overall situation of patients,preventing complications,and protecting the function of organs during the treatment of severe trauma in ICU.

Susceptibilidade de duas linhagens comerciais de frango de corte no desenvolvimento de dermatite necrótica e possível relação dos genes iss e iutA de Escherichia coli com a reprodução experimental da doença / Susceptibility of two commercial lineages of broilers in the development of necrotic dermatitis and relationship of iss and iutA genes from Escherichia coli with the experimental reproduction of the disease

Celulite aviária é uma enfermidade de grande importância para a avicultura mundial, sendo relacionada principalmente à Escherichia coli (E. coli). Neste estudo foi comparada a susceptibilidade de duas linhagens de aves no desenvolvimento da celulite diante do desafio com diferentes concentrações de E. coli. Além disso, foi avaliada a relação dos genes iss e iutA com a patogenicidade de amostras de E. coli de diferentes origens (fecal/casos clínicos) em pintinhos e com a reprodução experimental da doença em aves de 35 dias de idade. Através da inoculação de frangos de corte (Cobb/Ross) com diferentes níveis de desafio (105 a 108 UFC/mL) de E. coli, não foram observadas diferenças significativas entre as linhagens quanto à sensibilidade à dermatite necrótica para a mesma dosagem (p≤0,05). A detecção dos genes iss e iutA demonstrou que estes estiveram presentes somente nas amostras provenientes de casos clínicos. Da mesma forma, estes isolados foram considerados de alta patogenicidade para pintinhos (>80% letalidade), levando a formação de áreas de lesão mais extensas (≥3cm2) em aves de 35 dias, quando comparado às amostras de origem fecal (p≤0,05). Ainda, as diferenças com relação ao tamanho de lesão foram constatadas também entre os isolados de mesma origem (p≤0,05). Desta forma, a linhagem não pode ser considerada um fator primordial para o desenvolvimento de dermatite necrótica em frangos. Ainda, sugere-se que os genes iss e iutA, quando presentes em conjunto ou isoladamente, poderiam ser considerados marcadores de virulência em cepas de E. coli causadoras de celulite aviária.(AU)

Avian cellulitis is a disease of great importance for the global poultry industry, being mainly related to Escherichia coli. In this study the susceptibility of two lineages of broilers in the development of cellulite was compared to the challenge with different concentrations of E. coli. In addition, it evaluated the relationship of the iss and iutA genes with pathogenicity of E. coli samples from different origins (fecal/clinical cases) in chicks and with the experimental reproduction of disease in 35-day-old broilers. By inoculating broilers (Cobb/Ross) with different levels of challenge (105-108 CFU/mL) of E. coli, no significant differences had been observed between strains for sensitivity to necrotic dermatitis for the same dosage (p≤0.05). Detection of the iss and iutA genes showed that they were only present in samples from clinical cases. Likewise, these strains were considered high pathogenicity for chickens (>80% lethality), leading to the formation of more extensive lesion areas (≥3cm2) at 35 days of birds compared to the samples from fecal origin (p≤0.05). Still, the differences with respect to lesion size were also found among isolates of the same origin (p≤0,05). Thus, the lineage can not be considered a primary factor in the development of necrotic dermatitis in broilers. Furthermore, it is suggested that iss and iutA genes, when present together or separately, could be considered as virulence markers for E. coli strains that cause avian cellulite.(AU)

Derrubada dos vetos na Lei Complementar 157/2016 ­ Lei do ISS ­ primeiras impressões

O presente artigo tem o escopo de analisar a derrubada dos vetos na Lei Complementar nº 157/2016 que dispõe sobre o Imposto Sobre Serviço de Qualquer Natureza. Em 30 de dezembro de 2016 foi publicada a Lei Complementar nº 157, que alterou e acrescentou alguns artigos à Lei Complementar nº 116/03 ­ Lei Geral do ISS ­ atingindo a tributação de todos os Municípios brasileiros. A Presidência da República realizou alguns vetos, especialmente no que tange à alteração do local da incidência, do estabelecimento prestador para o local da prestação do serviço, no leasing, cartão de crédito e débito, e planos de saúde.

Prognostic value of the revised international staging system for newly diagnosed multiple myeloma patients / 中华血液学杂志

Objective@#To assess the prognostic value of revised international staging system (R-ISS) for multiple myeloma (MM) in real world.@*Methods@#A total of 202 newly diagnosis symptomatic MM patients were enrolled from May 2010 to April 2015 and the clinical data were retrospectively analyzed. All the patients received at least four courses of bortezomib-based or thalidomide-based induction therapy.@*Results@#With a median follow-up of 31 months, the cohort included 56 cases in R-ISSⅠ, 108 in R-ISS Ⅱ, and 38 in R-ISS Ⅲ, and the median OS was not reached/61/38 months, respectively (P=0.001). According to the ISS system, 62 patients were classified in ISS-Ⅰ, 70 in ISS-Ⅱ and 70 in ISS-Ⅲ, with the median OS was 58, 52 and 40 months, respectively (P=0.001). The relative risk (HR) of R-ISS stage Ⅲ vs Ⅰ, Ⅱ vs Ⅰ were 9.606 (P=0.008) and 4.038 (P=0.029). The HR of Ⅲ vs Ⅰ, Ⅱ vs Ⅰ of ISS system were 4.127 (P=0.070) and 2.877 (P=0.005). In the subgroup analysis, R-ISS predicted survival for patients who were not transplanted (P=0.003) , receiving bortezomib-based therapy (P=0.010) , and patients younger than 65 years (P=0.001).@*Conclusion@#R-ISS system could better predict prognosis for OS in unselected nonclinical trial myeloma patients than ISS system, especially for the younger patients, patients with bortezomib-based therapy, and patients without transplantation.

Analysis of prognostic factors for severe multiple trauma patients in ICU / 中国综合临床

Objective To explore the risk factors in the prognosis of patients with severe multiple trauma related factors.Methods Ninety-three patients with severe multiple trauma(ISS score≥16 points) were selected as our subjects,who all hospitalized in the second hospital affiliated to Dalian medical University.Among of which,38 cases' ISS score was 16-25,and 55 cases' ISS score was higher and equal to 25.Clinical data and general information were recorded.ISS score,APACHE Ⅱ score and 6 h lactate clearance rate score were measured.Results Twenty-seven dead among these 93 cases and the mortality was 29.03％.There were significant differences in terms of ISS score,APACHE Ⅱ score,lactate level when entering ICU,6 h lactate level and 6 h lactate clearance rate between death patients (27 cases) and survival patients (66 cases) (t =9.846,9.812,7.112,7.012,9.831 ; P ＜ 0.001).In multiple organ dysfunction syndrome (MODS) patients,the mortality of ISS score:16-25 group was different from that of ISS score≥25 (15.78％ (6/38) vs.35.18％ (21/93),x2 =21.52,P ＜0.001).Among the 93 cases of severe multiple trauma,35 cases with MODS(37.6％ (35/93)),and 20 cases of which were dead(57.1％ (20/35)).There was statistic difference between MODS group(35 cases) and non-MODS(58 cases) in term of mortality(37.6％ (35/93) vs.12.1％ (7/58) ;x2 =21.52,P ＜ 0.001).Multivariate logistic regression analysis showed that the ISS score,APACHE Ⅱ score,6 h lactate clearance rate and MODS were independently prognostic correlation factors (P ＜ 0.05).Operating characteristic curve (ROC) showed that AUC of ISS score was 0.735 (95 ％ CI 0.629-0.842),of APACHE Ⅱ score was 0.888 (95％ CI 0.821 =0.956),of 6 h lactate clearance rate score was 0.951 (95％ CI 0.906 -0.997).Conclusion The factors of ISS score,APPCHE Ⅱ assessment,6 h lactate clearance rate,the occurrence of MODS are independent prognostic factors.

Detecção de fatores de virulência de Escherichia coli e análise de Salmonella spp. em psitacídeos / Detection of virulence factors in Escherichia coli and analysis of Salmonella spp. in psittacines

The enteric flora of psittacines is mainly composed of Gram positive bacteria. Gram negative bacteria, like Escherichia coli and Salmonella spp., have a high pathogenic potential and can be considerate as an indicative of management problems that may culminate in disease manifestation due to stress factors, poor diets and overcrowding, in combination with a high bacterial load on the environment. The objective of this study was evaluated the presence of Salmonella spp., Escherichia coli and the virulence genes iss and iutA from E. coli isolates. Forty-four samples were analyzed from psittacines living in captivity, which fifteen samples were from organs fragments of necropsied birds, and twenty-nine were from cloacal and crop swabs of red-spectacled parrots (Amazona pretrei) keeping in captivity. No samples were positive for Salmonella spp. In the samples in which E. coli was detected, both virulence factors (genes iss and iutA) were present.

A flora entérica dos psitacídeos é composta principalmente por bactérias Gram positivas. Bactérias Gram negativas, como Escherichia coli e Salmonella spp., apresentam elevado potencial patogênico, sendo consideradas indicativo de problemas de manejo, que poderão culminar em manifestação de doenças em decorrência de fatores estressantes, dietas deficientes e superlotação, combinados com alta carga bacteriana no ambiente. O objetivo deste trabalho foi avaliar a presença de Salmonella spp., Escherichia coli e os fatores de virulência dos genes iss e iutA dos isolados de E. coli. Analisou-se um total de 44 amostras provenientes de psitacídeos criados em cativeiro, sendo estas 15 fragmentos de órgãos de aves submetidas a exame de necropsia e também 29 amostras de swabs de cloaca e inglúvio de papagaios-charão (Amazona pretrei) criados em cativeiro. Nenhuma amostra foi positiva para Salmonella spp. Nas amostras de E. coli detectou-se ambos os fatores de virulência pesquisados.

Analysis of Medical Costs for Trauma Patients

PURPOSE: We analyzed the medical costs for severely traumatized patients according to the severity and medical performance so that we couldimprove the financial balance of the trauma center. METHODS: Retrospective analysis was performed on patients visitingSNUH Trauma Center from May 2011 to August 2011. Among a total of 55 severely traumatized patients, 31 patients whose medical bills were available and categorized were included in this study. The injury severity score (ISS) was calculated from the abbreviated injury score (AIS), which was updated in 2008,for each patient to assess the severity of injury. Major trauma was defined as an ISS above 15. RESULTS: The 31 patients in this study included 20 males and 11 females. The average ISS was 33.23+/-16.65 points.We categorize the patients into three groups according to ISS, 16-24: group 1, 25-40: group 2, and above 41: group 3. Total incomes, admission fees, surgery fees, and imaging test fees are shown in table 1. The costs seem to be higher costs in group 2, but this result has no statistical significance. Statistical significantly data are as follows: high radiologic test fees in group 1, short hospital stay in groups 1 and 2, and short ICU stay in group 1. The averagehospital stay was 17 days, and the average emergency intensive care unit (EICU) stay was 7.5 days. Although the EICU stay was only 44% of the total hospital stay, the income from the EICU covers 79.4% of the total hospital income. CONCLUSION: From this study, we found several items that show relatively high medical income from severely traumatized patients visiting the SNUH Trauma Center. Most of the medical fees arise in the early phase of acute medicine usually in the ICU. Efforts to identify the items with high income and to minimize expenses will improve the financial structure of the Trauma Center,which is facing a budget crisis.

Perfil demográfico y clínico de pacientes traumatizados en una institución de cuarto nivel de complejidad, Medellín 2005-2008 / Demographic and clinical profile of trauma patients: a fourth-level institution, Medellin, 2005-2008

Objetivo: describir el comportamiento demográfico y clínico de los pacientes traumatizados de una institución de cuarto nivel de complejidad que ingresaron entre el 2005 y el 2008. Metodología: estudio descriptivo retrospectivo basado en información de pacientes que ingresaron a urgencias y hospitalización. Se estimaron frecuencias y porcentajes para las variables demográficas y algunas clínicas. Finalmente, se realizó un muestreo aleatorio simple para estimar la puntuación de gravedad de las lesiones (trauma and injury severity score-triss). Resultados: en este período ingresaron 165736 pacientes, de ellos, 57382 correspondieron a ingresos por trauma (35% del total). El sexo masculino y el grupo de edad de 20-29 años fueron los más afectados. La causa de ingreso predominante fue la de accidentes de tránsito, seguida por otros tipos de accidentes (caídas, quemaduras, ahogamientos). Fueron hospitalizados 6721 pacientes, de los cuales fallecieron 278, con tasa de mortalidad global de 4,1. La parte del cuerpo más afectada en estos pacientes fueron las extremidades (42%) y los traumas en cabeza y cuello (19%). Para estimar la triss, se analizaron en total 347 pacientes. El índice de severidad del trauma (iss) calculado fue mayor de 49 en 3,17% de los pacientes analizados. La escala revisada de trauma (rts) promedio fue de 7507. Las cifras de presión arterial sistólica y frecuencia respiratoria presentaron una media de 121,948 mmHg y 18,659 min respectivamente, y en la escala de coma de Glasgow, 30 pacientes obtuvieron un puntaje menor o igual a 8. El total de muertes esperadas correspondió a 17 pacientes y el total de muertes observadas a 19. Finalmente, la triss calculada fue de 1,097...

Objective: to describe the demographic and clinical behavior of trauma inpatients admitted in an institution of fourth level of complexity between 2005 and 2008. Methodology: descriptive and retrospective study based on information from patients admitted to the emergency room and to stay hospitalized. Frequencies and percentages for both demographic and inical variables were estimated. Finally, a simple random sampling was conducted to estimate the trauma and injury severity score (triss). Results: during this period a total amount of 165736 inpatients were admitted; 57382 of them were admitted for trauma (35% Perfil demográfico y clínico de pacientes traumatizados: en una institución de cuarto nivel. Medellín 2005-2008 Facultad Nacional de Salud Pública 243 of the total). The male gender and the 20-29 years of age groups were the most affected by trauma. The predominant cause of admission was traffic accidents followed by other types of accidents (falls, burns, drowning). 6721 patients were hospitalized, 278 of which died while the general mortality rate was 4,1. The most affected body part in those patients was the body limbs (42%) and trauma to the head and neck (19%). In order to estimate the triss, a total amount of 347 patients we analyzed. The estimated triss scored more than 49 for 3,17% of the patients studied, the average was 7,507 rts, the systolic blood pressure and the respiratory rate showed an average of 121,948 mmHg and 18,659 minutes respectively, and according to the Glasgow coma scale, 30 patients scored less than or equal to 8. The total amount of expected deaths was 17 patients and the total amount of observed deaths was 19. Finally, the triss calculated was 1.097...

Perfil de sensibilidade antimicrobiana e detecção do gene ISS pela reação em cadeia da polimerase na tipificação de escherichia coli patogênica em codornas de corte sob inspeção sanitária / Profile of antimicrobial resistance and detection of iss gene by the polymerase chain reaction in the typification of pathogenic escherichia coli in meat type quails under sanitary inspection

A patogenicidade das cepas de Escherichia coli está relacionada à expressão de fatores de virulência encontrados em elementos genéticos denominados plasmídios. O patotipo APEC, responsável por diferentes tipos de doenças em aves, pode apresentar o gene iss que aumenta a resistência das cepas de E. coli aos efeitos líticos do soro, além da resistência a diversos antimicrobianos. Este estudo foi conduzido para detectar E. coli em traquéias de codornas destinadas ao abate e avaliar, pela presença do gene iss e o perfil de susceptibilidade antimicrobiana, o potencial patogênico para aves e humanos dos isolados obtidos. Foram coletadas 180 traquéias de codornas para detecção de E. coli, determinação do perfil de resistência a agentes antimicrobianos e posterior detecção, por reação em cadeia da polimerase (PCR), do gene iss. Das traquéias analisadas, 8,9 por cento (16/180) foram positivas para E. coli, sendo obtidos 20 isolados deste agente. A maioria dos isolados foi resistente à Tetraciclina (16/20), seguida pela Ceftazidima (13/20) e Ácido Nalidíxico (12/20), sendo apenas um resistente à Amoxicilina. A detecção do gene iss ocorreu em 55 por cento (11/20) dos isolados. A presença do gene iss e a resistência a múltiplos antimicrobianos dos isolados obtidos neste estudo pode indicar um possível potencial patogênico das cepas de E. coli tanto para codornas quanto para outros tipos de aves e animais e mesmo para o ser humano que fique em contato com as mesmas.

The pathogenicity of Escherichia coli strains is partially related to the expression of virulence factors genes, present in genetic elements called plasmids. APEC strains responsible for diseases in birds may present the iss gene which increases the resistance of E. coli strains to the lityc effect of the host's serum, besides resistance to several antimicrobials. This study was conduced in order to detect E. coli in tracheae of meat-type quails and to evaluate, by the presence of the iss gene and the profile of antimicrobial susceptibility, the pathogenic potential of the isolated samples for birds and humans. One hundred and eighty tracheae of quails were collected for detection of E. coli, antimicrobial sensitivity tests, and for polymerase chain reaction (PCR), for detection of iss gene. From the examined quails, 8.9 percent (16/180) were positive for E. coli, from which 20 strains of this bacterium were obtained. Most of them were resistant to Tetracycline (16/20), followed by Ceftadizime (13/20) and Nalidixic-acid (12/20) and only one isolate was resistant to Amoxicillin. The detection of iss gene occurred in 55 percent (11/20) of the isolates, indicating that these strains had the potential to be pathogenic not only for quails, but also for other kinds of birds, other animals and even human beings that would be in contact with these E. coli isolates.

Early Traumatic Deaths

PURPOSE: In Korea, trauma is the 3rd most common cause of death. The trauma treatment system is divided into pre-hospital and hospital stages. Deaths occurring in the pre-hospital stage are 50% of the total death, and 20% of those are deaths that are preventable. Therefore, the purpose of our study is to calculate the preventable death rates caused by trauma in our current pre-hospital system, to analyze the appropriateness of the treatment of traumatized patients and to draw a conclusions about the problems we have. METHODS: The study was done on traumatized patients who expired at the emergency department from January 1, 2005, to December 31, 2009, at the Korea University Medical Centers in Anam, Guro and Ansan. The data on the patients were reviewed retrospectively based on characteristics, conditions on admission and trauma severity. The patient's RTS (revised trauma score) and ISS (injury severity score) was calculated. Preventable death rate was calculated by TRISS (the trauma score-injury severity score). RESULTS: A total of 168 patients were enrolled. All patients were intubated and underwent CPR. Of the total, 72% patients were male, and traffic accidents were the most common form of trauma (52.4%), falls being second (28.6%). Head injury, solitary or multiple, was the most common cause of death (55.4%). Thirty-eight (38, 22.6%) deaths were preventable. The 22.6% preventable death rate consisted of 15.5% potentially preventable and 7.1% definitely preventable deaths. Based on a logistic regression analysis, the relationship between the time intervals until transfusion and imaging and death was statistically significant in the hospital stage. In the pre-hospital stage, transit time from the site of the injury to the hospital showed a significant relationship with the mortality rate. CONCLUSION: One hundred sixty-eight (168) patients died of trauma at the 3 hospitals of Korea University Medical Center. The TRISS method was used to calculate the preventable death rate, with a result of 22.6%. The only factor that was significant related to the preventable death rate in the pre-hospital stage was the time from injury to hospital arrival, and the time intervals until transfusion and imaging were the two factors that showed significance in the hospital stage. Shortening the time of treatment in the field and transferring the patient to the hospital as quickly as possible is the most important life-saving step in the pre-hospital stage. In the hospital stage, the primary survey, resuscitation and diagnosis should proceed simultaneously.

Comparison of Injuries Related with All-Terrian Vehicles (ATVs) and Motorcycles (MCs)

PURPOSE: All-terrain vehicle (ATV)-related injuries have increased since the introduction of ATVs to Korea. The purpose of this study is to compare patients with ATV-related injuries (PATV) to patients with motorcycle (MC)-related injuries (PMC). METHODS: We retrospectively analyzed the clinical records of PATV and PMC who visited an emergency center in 2008. The cases of PMC were 164, and those of PATV were 52. RESULTS: While PMC are seen evenly in the first half year and the second half year, PATV are seen mainly the first half year (from March to June: 73%). For PMC the most frequent injury mechanism was collision with another vehicle, while for PATV, it was side overturn/roll over. The injury severity score (ISS), the revised trauma score (RTS), the trauma score and the injury severity score (TRISS) were 5.6+/-5.6, 7.7+/-0.7, 5.0+/-2.1 for PMC and 7.1+/-7.5, 7.7+/-1.1, 5.5+/-1.5 for PATV, respectively. The most common injury sites were the lower extremities for PMC and the face for PATV. The rates of admission, surgery and the length of hospital stay were similar between PMC and PATV. CONCLUSION: This study shows that the risk of ATV accidents is similar to that of MC accidents. We recommend that the same safety standards and regulations that are applied to MCs should be used for ATVs. Safe and enjoyable paths have to be sought for drivers of ATVs.

Uso do escore prognóstico APACHE II e ATN-ISS em insuficiência renal aguda tratada dentro e fora da unidade de terapia intensiva / APACHE II and ATN-ISS in acute renal failure (ARF) in intensive care unit (ICU) and non-ICU

INTRODUÇÃO: A insuficiência renal aguda (IRA) mantém alta prevalência, morbidade e mortalidade. OBJETIVO: Comparar o uso do escore prognóstico APACHE II com o ATN-ISS e determinar se o APACHE II pode ser utilizado para pacientes com IRA, fora da UTI. MÉTODOS: Coorte prospectiva, 205 pacientes com IRA. Analisamos dados demográficos, condições pré-existentes, falência de órgãos e características da IRA. Os escores prognósticos foram realizados no dia da avaliação do nefrologista. RESULTADOS: A média de idade foi 52 ± 18 anos, 50 por cento eram do sexo masculino, 69 por cento eram brancos, 45 por cento foram tratados em UTI e 55 por cento em outras unidades. A mortalidade no grupo UTI foi 85 por cento e no grupo não-UTI foi 18 por cento. Os fatores que se correlacionaram com maior mortalidade foram mais prevalentes na UTI: idade, sexo masculino, IRA hospitalar, falência de órgãos, sepse, IRA séptica, oligúria e necessidade dialítica. No contexto geral, os marcadores prognósticos foram os mesmos para os grupos UTI e não-UTI. O APACHE II obteve discriminação similar nos grupos UTI e não-UTI e sua calibração foi melhor no grupo não-UTI. O ATN-ISS obteve boa discriminação tanto no grupo UTI quanto não-UTI, porém, com relação à calibração houve discreta superestimação da mortalidade no grupo não-UTI. O ATN-ISS apresentou melhor capacidade de discriminação do que o APACHE II nos grupos UTI e não-UTI. CONCLUSÃO: Concluímos que os escores APACHE II e ATN-ISS podem ser utilizados para a estratificação de risco em pacientes com IRA tratados fora da UTI em nosso meio.

INTRODUCTION: Acute renal failure (ARF) remains highly prevalent with a high rate of morbidity and mortality. OBJECTIVE: of this study was to compare use of the APACHE II scoring prognosis with that of the ATN-ISS to determine whether the APACHE II could be used for patients with ARF outside the ICU. METHODS: For this purpose,, 205 patients with ARF were accompanied in a prospective cohort. Demographic data, preexisting conditions, organ failure and characteristics of ARF were analyzed. The prognostic scores were performed with the assessment of a nephrologist. RESULTS: The mean age was 52 ± 18 years, 50 percent were male, 69 percent were white, 45 percent were treated in ICU and 55 percent in other units. Mortality in the ICU group was 85 percent and in the non-ICU group 18 percent. Factors that correlated with higher mortality were more prevalent in the ICU group: age, male, hospitalization with ARF, organ failure, sepsis, septic IRA, oliguria and need of dialysis. Overall, the prognostic markers were the same for both the ICU and non-ICU groups. The discrimination with the APACHE II was similar in both, ICU and non-ICU groups and calibration was better in the non-ICU group. The ATN-ISS achieved good discrimination in both the ICU and non-ICU groups, but, regarding calibration, there was a discreet over estimating of mortality in the non-ICU group. The ATN-ISS showed a greater capacity for discrimination than the APACHE II in both the ICU and non-ICU groups. CONCLUSION: It was concluded that the APACHE II and ATN-ISS scores could be used for stratification of risk in patients with ARF treated outside of the ICU in Brazil.