COVID-19: presentación clínica en adultos / COVID-19: clinical features in adult patients

Este artículo resume las diferentes formas de presentación clínica de la enfermedad COVID-19 causada por el virus SARS-Co-2 documentadas fundamentalmente en las tres principales revisiones sistemáticas disponibles. Entre las manifestaciones clínicas de frecuente aparición se destacan la fiebre (83 %), la tos (60 %) y la fatiga (38 %), seguidas por las mialgias (29 %), el aumento de la producción del esputo (27 %) y la disnea (25 %). Entre los hallazgos de laboratorio,predominan el aumento de los valores de proteína C reactiva (69 %), la linfopenia (57 %) y el aumento de los niveles de lactato-deshidrogenasa (52 %). Respecto de las manifestaciones radiológicas, tienen especial importancia las opacificaciones en vidrio esmerilado (80 %), la neumonía bilateral (73 %) y la afectación de tres lóbulos pulmonares o más (57 %).Si bien la evidencia sintetizada tiene limitaciones, permite una aproximación actualizada a los conocimientos disponibles sobre la clínica de esta nueva enfermedad en la población adulta. (AU)

This article summarizes the different forms of clinical presentation of COVID-19, caused by the SARS-Co-2 virus, synthesizing the information collected mainly by three published systematic reviews. Frequent clinical manifestations include fever(83 %), cough (60 %), and fatigue (38 %), followed by myalgia (29 %), increased sputum production (27 %) and dyspnea(25 %). Among the laboratory findings, the most common are the increase in C-reactive protein values (69 %), lymphopenia (57 %) and the increase in lactate dehydrogenase levels (52 %).. Most remarkable radiological features include ground glass opacifications (80 %), bilateral pneumonia (73 %) and the involvement of three or more lung lobes (57 %). Although the synthesized evidence has limitations, it allows an updated approach to the available knowledge about the clinical symptoms of this new disease in the adult population. (AU)

The effect of high-dose vitamin c on biochemical markers of myocardial injury in coronary artery bypass surgery

Abstract Objective: To evaluate the effect of high-dose vitamin C on cardiac reperfusion injury and plasma levels of creatine kinase-muscle/brain (CK-MB), troponin I, and lactate dehydrogenase (LDH) in patients undergoing coronary artery bypass grafting (CABG). Methods: This is a double-blind randomized clinical trial study. Fifty patients (50-80 years old) who had CABG surgery were selected. The intervention group received 5 g of intravenous vitamin C before anesthesia induction and 5 g of vitamin C in cardioplegic solution. The control group received the same amount of placebo (normal saline). Arterial blood samples were taken to determine the serum levels of CK-MB, troponin I, and LDH enzymes. Left ventricular ejection fraction was measured and hemodynamic parameters were recorded at intervals. Results: High doses of vitamin C in the treatment group led to improvement of ventricular function (ejection fraction [EF]) and low Intensive Care Unit (ICU) stay. The cardiac enzymes level in the vitamin C group was lower than in the control group. These changes were not significant between the groups in different time intervals (anesthesia induction, end of bypass, 6 h after surgery, and 24 h after surgery) for CK-MB, LDH, and troponin I. Hemodynamic parameters, hematocrit, potassium, urinary output, blood transfusion, arrhythmia, and inotropic support showed no significant difference between the groups. Conclusion: Vitamin C has significantly improved the patients' ventricular function (EF) 72 h after surgery and reduced the length of ICU stay. No significant changes in cardiac biomarkers, including CK-MB, troponin I, and LDH, were seen over time in each group. IRCT code: IRCT2016053019470N33

Testicular mixed germ cell tumor presenting with seizure as the initial symptom: a case report and literature review

Abstract Most patients with testicular germ cell tumor present with a painless scrotal mass. We report a 19-year-old patient who presented with neurological complains. Rapid clinical progression to coma was noted during the staging work up. A diagnosis of testicular mixed germ cell tumor with multiorgan metastasis (lymph node, lung, liver and brain) was made. Patients with brain metastasis should receive chemotherapy alone or combined with surgery or radiotherapy. Because the clinical symptoms deteriorated quickly, surgery was used upfront followed by chemotherapy and radiotherapy for the brain tumor. After the first stage of treatment, the clinical symptoms, tumor markers and imaging findings were improved. The residual brain tumor was eliminated by chemotherapy, and only sparse degenerated tumor cells were noted in the brain tissue. Longer follow up is required to assess the impact of our treatment strategy.

Local and systemic effects caused by Crotalus durissus terrificus, Crotalus durissus collilineatus, and Crotalus durissus cascavella snake venoms in swiss mice

Abstract INTRODUCTION: Crotalus envenomations cause serious complications and can be fatal without appropriate treatment. Venom isoforms present and inter/intraspecific variations in the venom composition can result in different symptoms presented by bites by snakes from the same species but from different geographical regions. We comparatively evaluated the local and systemic effects caused by Crotalus durissus terrificus (Cdt), C.d. collilineatus (Cdcolli), and C.d. cascavella (Cdcasc) envenomation. METHODS: Venom chromatography was performed. Proteolytic, phospholipase, and LAAO activities were analyzed. Edema, myotoxicity, hepatotoxicity, nephrotoxicity, and coagulation alterations were evaluated. RESULTS: The venom SDS-PAGE analyses found the presence of convulxin, gyroxin, crotoxin, and crotamine in Cdt and Cdcolli venoms. Crotamine was not present in the Cdcasc venom. Cdt, Cdcollli, and Cdcasc venoms had no proteolytic activity. Only Cdcasc and Cdt venoms had phospholipase activity. LAAO activity was observed in Cdcolli and Cdcasc venoms. Cdcolli and Cdcasc venoms caused 36.7% and 13.3% edema increases, respectively. Cdt venom caused a 10% edema induction compared to those by other venoms. All venoms increased TOTAL-CK, MB-CK, and LDH levels (indicating muscle injury) and ALT, AST, GGT, and ALP levels (markers of liver damage) and were able to induce a neuromuscular blockade. Urea and creatinine levels were also altered in both plasma and urine, indicating kidney damage. Only Cdcolli and Cdcasc venoms increased TAPP and TAP. CONCLUSIONS: Together, these results allow us to draw a distinction between local and systemic effects caused by Crotalus subspecies, highlighting the clinical and biochemical effects produced by their respective venoms.

Alprostadil attenuates myocardial ischemia/reperfusion injury by promoting antioxidant activity and eNOS activation in rats

Abstract Purpose: To investigate the effect of alprostadil on myocardial ischemia/reperfusion (I/R) in rats. Methods: Rats were subjected to myocardial ischemia for 30 min followed by 24h reperfusion. Alprostadil (4 or 8 μg/kg) was intravenously administered at the time of reperfusion and myocardial infarct size, levels of troponin T, and the activity of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) in the serum were measured. Antioxidative parameters, nitric oxide (NO) content and phosphorylated endothelial nitric oxide synthase 3 (p-eNOS) expression in the left ventricles were also measured. Histopathological examinations of the left ventricles were also performed. Results: Alprostadil treatment significantly reduced myocardial infarct size, serum troponin T levels, and CK-MB and LDH activity (P<0.05). Furthermore, treatment with alprostadil significantly decreased malondialdehyde (MDA) content (P<0.05) and markedly reduced myonecrosis, edema and infiltration of inflammatory cells. Superoxide dismutase and catalase activities (P<0.05), NO level (P<0.01) and p-eNOS (P<0.05) were significantly increased in rats treated with alprostadil compared with control rats. Conclusion: These results indicate that alprostadil protects against myocardial I/R injury and that these protective effects are achieved, at least in part, via the promotion of antioxidant activity and activation of eNOS.

Protective effects of baicalin on experimental myocardial infarction in rats

Abstract Objective: This study aimed to investigate the protective effects of baicalin on myocardial infarction in rats and explore the related mechanisms. Methods: Fifty Sprague Dawley rats were randomly divided into the control, model, and low-, medium- and high-dose baicalin groups. The latter 3 groups were intraperitoneally injected with baicalin, with a dose of 12.5, 25 and 50 mg/kg, respectively. Then, the myocardial infarction model was established. The hemodynamic of rats was tested, the serum lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB), prostacyclin (PGI2) and thromboxane A2 (TXA2) were determined, the myocardial superoxide dismutase (SOD) and malondialdehyde (MDA) levels were detected, and the myocardial B-cell lymphoma-2 (Bcl-2) and Bcl-2 associated X (Bax) protein expressions were determined. Results: Compared with the model group, in the high-dose baicalin group the ST segment height and LVEDP were significantly decreased (P<0.05), the LVSP was significantly increased (P<0.05), the serum LDH, CK-MB and TXA2 levels were significantly decreased (P<0.05), the PGI2 level was significantly increased (P<0.05), the myocardial SOD level was significantly increased (P<0.05), and the myocardial MDA level was significantly decreased (P<0.05); the myocardial Bcl-2 protein level was significantly increased, and the Bax protein level was significantly decreased (P<0.05). Conclusion: Baicalin has protective effects on myocardial infarction in rats. The possible mechanisms may be related to its resistance to oxidative stress, and up-regulation of Bcl-2 protein expression and down-regulation of Bax protein expression in myocardial tissue.

Cardioprotective effect of lipstatin derivative orlistat on normotensive rats submitted to cardiac ischemia and reperfusion

Abstract Purpose: To evaluate in vivo animal model of cardiac ischemia/reperfusion the cardioprotective activity of pancreatic lipase inhibitor of the orlistat. Methods: Adult male Wistar rats were anesthetized, placed on mechanical ventilation and underwent surgery to induce cardiac I/R by obstructing left descending coronary artery followed by reperfusion to evaluation of ventricular arrhythmias (VA), atrioventricular block (AVB) and lethality (LET) with pancreatic lipase inhibitor orlistat (ORL). At the end of reperfusion, blood samples were collected for determination of triglycerides (TG), very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase-MB (CK-MB). Results: Treatment with ORL has been able to decrease the incidence of VA, AVB and LET. Besides that, treatment with ORL reduced serum concentrations of CK and LDL, but did not alter the levels of serum concentration of TG, VLDL and HDL. Conclusion: The reduction of ventricular arrhythmias, atrioventricular block, and lethality and serum levels of creatine kinase produced by treatment with orlistat in animal model of cardiac isquemia/reperfusion injury suggest that ORL could be used as an efficient cardioprotective therapeutic strategy to attenuate myocardial damage related to acute myocardial infarction.

Acute kidney injury and other factors associated with mortality in hiv-infected patients

SUMMARY OBJECTIVE: HIV-related mortality is still high, especially in developed countries. The aim of this study is to investigate factors associated to death in HIV-infected patients. METHODS: This is a cross-sectional study with all HIV adult patients admitted to a tertiary infectious diseases hospital in Fortaleza, Northeast Brazil, from January 2013 to December 2014. Patients were divided into two groups: survivors and non-survivors. Demo-graphical, clinical and laboratory data were compared and a logistic regression was performed in order to investigate risk factors for death. P values ≤0.05 were considered statistically significant. RESULTS: A total of 200 patients with mean age of 39 years were including in the study, 69.5% males. Fifteen patients (7.5%) died. Non-survivors presented a higher percentage of males (93.3 vs. 67.3%, p = 0.037). Non-survivors presented AKI (73.3 vs. 10.3%, p < 0.001), liver dysfunction (33.3 vs. 11.5, p = 0.031), dyspnea (73.3 vs. 33.0%, p = 0.002) and disorientation (33.3 vs. 12.4%, p = 0.025) more frequently. Non-survivors also had higher levels of urea (73.8 ± 52.7vs. 36.1 ± 29.1 mg/dL, p < 0.001), creatinine (1.98 ± 1.65 vs. 1.05 ± 1.07 mg/dL, p < 0.001), aspartate aminotransferase (130.8 vs. 84.8 U/L, p = 0.03), alanine aminotransferase (115.6 vs. 85.4 U/L, p = 0.045) and lactate dehydrogenase (LDH) (1208 vs. 608 U/L, p = 0.012), as well as lower levels of bicarbonate (18.0 ± 4.7 vs. 21.6 ± 4.6 mEq/L, p = 0.016) and PCO2 (27.8 ± 7.7 vs. 33.0 ± 9.3 mmHg, p = 0.05). In multivariate analysis, disorientation (p = 0.035, OR = 5.523, 95%CI = 1.130 - 26.998), dyspnoea (p = 0.046, OR = 4.064, 95%CI = 1.028 - 16.073), AKI (p < 0.001, OR = 18.045, 95%CI = 4.308 - 75.596) and disseminated histoplasmosis (p = 0.016, OR = 12.696, 95%CI = 1.618 - 99.646) and LDH > 1000 U/L (p = 0.038, OR = 4.854, 95%CI = 1.093 - 21.739) were risk factors for death.]CONCLUSION: AKI and disseminated histoplasmosis (DH) were the main risk factors for death in the studied population. Neurologic and respiratory impairment as well as higher levels of LDH also increased mortality in HIV-infected patients.

RESUMO INTRODUÇÃO: A mortalidade relacionada ao HIV ainda é alta, especialmente nos países em desenvolvimento. O objetivo deste estudo é investigar os fatores associados ao óbito em pacientes com HIV. MÉTODOS: Trata-se de um estudo transversal com todos os pacientes com HIV admitidos consecutivamente em um hospital terciário de doenças infecciosas em Fortaleza, Nordeste do Brasil, entre janeiro de 2013 e dezembro de 2014. Os pacientes foram divididos em dois grupos: sobreviventes e não sobreviventes. Dados demográficos, clínicos e laboratoriais foram comparados e análise de regressão logística foi feita para investigação dos fatores de risco para óbito. RESULTADOS: Um total de 200 pacientes, com média de idade de 39 anos, foi incluído no estudo, sendo 69,5% do sexo masculino. Óbito ocorreu em 15 pacientes (7,5%). Os não sobreviventes apresentaram maior percentual de homens (93,3 vs. 67,3%, p = 0,037) e um menor tempo de internação (8 ± 6 vs. 18 ± 15 dias, p = 0,005). Na análise multivariada, desorientação (p = 0,035, OR = 5,523), dispneia (p = 0,046, OR = 4,064), LRA (p < 0,001, OR = 18,045), histoplasmose disseminada (p = 0,016, OR = 12,696) e desidrogenase lática (LDH) > 1.000 U/L (p = 0,038, OR = 4,854) foram fatores de risco para óbito. CONCLUSÕES: LRA e histoplasmose disseminada foram os principais fatores de risco para óbito na população estudada. Distúrbios neurológicos e respiratórios, bem como níveis elevados de LDH, também estiveram associados com o aumento da mortalidade em pacientes com HIV.

Serum markers as an aid in the diagnosis of pulmonary fungal infections in AIDS patients

ABSTRACT Introduction: The etiology of pulmonary infections in HIV patients is determined by several variables including geographic region and availability of antiretroviral therapy. Materials and methods: A cross-sectional prospective study was conducted from 2012 to 2016 to evaluate the occurrence of pulmonary fungal infection in HIV-patients hospitalized due to pulmonary infections. Patients' serums were tested for (1-3)-β-D-Glugan, galactomannan, and lactate dehydrogenase. The association among the variables was analyzed by univariate and multivariate regression analysis. Results: 60 patients were included in the study. The patients were classified in three groups: Pneumocystis jirovecii pneumonia (19 patients), community-acquired pneumonia (18 patients), and other infections (23 patients). The overall mortality was 13.3%. The time since diagnosis of HIV infection was shorter in the pneumocystosis group (4.94 years; p = 0.001) than for the other two groups of patients. The multivariate analysis showed that higher (1-3)-β-D-Glucan level (mean: 241 pg/mL) and lactate dehydrogenase (mean: 762 U/L) were associated with the diagnosis of pneumocystosis. Pneumocystosis was the aids-defining illness in 11 out of 16 newly diagnosed HIV-infected patients. Conclusion: In the era of antiretroviral therapy, PJP was still the most prevalent pulmonary infection and (1-3)-β-D-Glucan and lactate dehydrogenase may be suitable markers to help diagnosing pneumocystosis in our HIV population.

Efeitos de um salgante isento de sódio sobre marcadores sanguíneos bioquímicos hepáticos, renais e cardíacos de ratos normo e hipertensos / Effects of a sodium-free salting agent on blood hepatic, renal and cardiac biochemical markers of normal and hypertensive rats

Introdução: A hipertensão arterial é um dos fatores de risco para doenças cardiovasculares, estando diretamente associada ao elevado consumo de sódio. Objetivo: Avaliar os níveis de marcadores de lesão hepática, renal e cardíaca em ratos hipertensos comparados aos seus controles normotensos, tratados com um salgante isento de sódio, água ou NaCl. Métodos: Ratos hipertensos (SHR) e seus controles normotensos (NWR) foram divididos em 3 grupos (n=7): G1 (água); G2 (solução aquosa contendo NaCl 70 mg/kg/dia); G3 (solução aquosa contendo salgante sem sódio 70 mg/kg/dia). Após 30 dias, o sangue dos animais foi processado. Resultados: Não houve diferença entre os níveis séricos de creatina quinase total, creatina quinase-MB, lactato desidrogenase, ácido úrico, aspartato aminotransferase e fosfatase alcalina tanto nos NWR como nos SHR tratados com NaCl ou Salgante. Houve diminuição da creatinina nos NWR e SHR tratados com NaCl e Salgante em relação aos controles (p<0,005). Conclusões: A suplementação diária com o Salgante e NaCl diminuiu os níveis séricos de creatinina nos grupos NWR e SHR. Contudo, não houve modificação nos níveis séricos de marcadores de lesão cardíaca e hepática. (AU)

Introduction: Hypertension is one of the risk factors for cardiovascular diseases, being directly associated with high consumption of sodium. Objective: To assess the levels of hepatic, renal and cardiac injury markers in hypertensive rats compared to their normotensive controls, treated with a salt free saline solution, water or NaCl. Methods: Hypertensive rats (SHR) and their normotensive controls (NWR) were divided into 3 groups (n = 7): G1 (water); G2 (aqueous solution containing NaCl 70 mg / kg / day); G3 (sodium salt-free aqueous solution 70 mg / kg / day). After 30 days, the animals' blood was processed. Results: There was no difference between serum levels of total creatine kinase, creatine kinase-MB, lactate dehydrogenase, uric acid, aspartate aminotransferase and alkaline phosphatase in both NWR and SHR1 treated NaCl or Salgante. There was a decrease in creatinine in NWR and SHR treated with NaCl and Salgante comparing to controls (p <0.005). Conclusions: Daily supplementation with sodium salt-free aqueous solution and NaCl decreases serum creatinine levels in NWR and SHR groups. However, there was no change in serum levels of cardiac and hepatic injury markers. (AU)

Obesity, Serum Resistin and Leptin Levels Linked to Coronary Artery Disease / Obesidade, Soro Resistina e Níveis de Leptina Ligados à Doença Arterial Coronariana

Abstract Background: Clinical studies have demonstrated that adipocytokines play an important role in developing atherosclerotic cardiovascular diseases. Objective: The aim of study was to evaluate the relationship between serum resistin and leptin levels with obesity and coronary artery disease (CAD). Methods: In a cross-sectional study, we assessed the levels of serum resistin and leptin, C-reactive protein (CRP), lipid profile and cardiac enzyme tests (AST, CPK, LDH, CK-MB) in 40 CAD patients compared to 40 healthy controls. Anthropometric measurements including weight and height for calculating of body mass index (BMI), and waist circumference (WC) were performed for evaluation of obesity. Results: CAD patients had increased levels of leptin and CRP, (p < 0.001), cholesterol (p < 0.05), triglyceride (p < 0.01), and WC (p < 0.05) compared to healthy controls. There was no statistical difference between CAD and control subjects for resistin (p = 0.058). In a multiple regression analysis, only an association between serum leptin with BMI (β = 0.480, p < 0.05) and WC (β = 1.386, p < 0.05) was found. Conclusions: The findings suggest that leptin is a better marker of fat mass value than resistin and may be considered an independent risk factor for cardiac disorders that is largely dependent on obesity. However, further prospective studies are needed to confirm these results.

Resumo Fundamento: Estudos clínicos demonstraram que adipocitocinas têm papel importante no desenvolvimento de doenças cardiovasculares ateroscleróticas. Objetivo: Avaliar a relação entre níveis de leptina e resistina em soro com obesidade e doença arterial coronariana (DAC). Métodos: Em estudo transversal, avaliamos os níveis de resistina e leptina em soro, proteína C-reativa (CPR), perfil lipídico e testes de enzimas cardíacas (AST, CPK, LDH, CK-MB) em quarenta pacientes com DAC comparados a 40 controles saudáveis. Para avaliação de obesidade, foram feitas as medições antropométricas, incluindo peso e altura para o cálculo do índice de massa corporal (IMC) e circunferência da cintura (CC). Resultados: Pacientes com DAC apresentaram aumento nos níveis de leptina e CPR, (p < 0,001), colesterol (p < 0,05), triglicérides (p < 0,01) e CC (p < 0,05) em comparação aos controles. Não houve diferença significativa entre DAC e controles com relação à resistina (p = 0,058). Na análise de regressão múltipla, foi encontrada apenas uma associação entre leptina em soro ao IMC (β = 0,480, p < 0,05) e CC (β = 1,386, p < 0,05). Conclusões: Os achados sugerem que a leptina é melhor marcadora de valor de massa gorda do que a resistina, e pode ser considerada um fator de risco, dependente da obesidade, independente para distúrbios cardíacos. Contudo, outros estudos prospectivos serão necessários para a confirmação desses resultados.

Análise de biomarcadores séricos de lesão muscular durante competição de mountain bike / Analysis of muscle injury serum biomarkers during a mountain bike competition

Introdução: O estudo de biomarcadores musculares permite diagnóstico de futuras lesões no esporte de alto nível. Objetivo: Avaliar a creatinoquinase (CK) e lactato desidrogenase (LDH) em atletas Mountain Bike. Métodos: Foram coletadas amostras sanguíneas de dez atletas de Elite de Mountain Bike. As coletas de sangue foram realizadas 24 horas antes da prova (T1), imediatamente ao final da corrida (T2), uma hora após a corrida (T3) e 24 horas depois da competição (T4). Resultados: A CK se elevou da ordem de 100% em 24 horas após a competição. Já LDH aumentou 43% em T2, permanecendo elevado até 1h após competição. A correlação entre os dois marcadores apresentou o coeficiente r = 0,80. Conclusão: O acompanhamento das concentrações de CK e LDH neste experimento foi possível estimar a recuperação pós-competição dos atletas em níveis de lesão muscular, o que se converte em valiosa ferramenta para a planificação e periodização do treinamento.

Introduction: Biomarkers muscles allows diagnosis of future injuries in overall sport. Objective: Evaluate the creatine kinase (CK) and lactate dehydrogenase (LDH) in Mountain Bike athletes. Methods: Blood samples of ten athletes Elite Mountain Bike was collected. The samples of blood were taken 24 hours before (T1) immediately at the end (T2), one hour after the race (T3) and 24 hour after competition (T4). Results: The CK amounted to around 100 % in 24 hours after the competition. LDH already increased by 43 % and remaining high until 1 hour after competition. The correlation between the two biomarkers showed coefficient r = 0.80. Conclusion: The monitoring of concentrations of CK and LDH in this experiment it was possible to estimate muscle injury post-competition, which becomes a valuable tool for planning and periodization of training.

Neuroprotective body hypothermia among newborns with hypoxic ischemic encephalopathy: three-year experience in a tertiary university hospital. A retrospective observational study / Hipotermia corpórea neuroprotetora em recém-nascidos com encefalopatia hipóxico-isquêmica: três anos de experiência em hospital universitário terciário. Um estudo observacional retrospectivo

CONTEXT AND OBJECTIVE:Neonatal hypoxic-ischemic encephalopathy is associated with high morbidity and mortality. Studies have shown that therapeutic hypothermia decreases neurological sequelae and death. Our aim was therefore to report on a three-year experience of therapeutic hypothermia among asphyxiated newborns.DESIGN AND SETTING:Retrospective study, conducted in a university hospital.METHODS:Thirty-five patients with perinatal asphyxia undergoing body cooling between May 2009 and November 2012 were evaluated.RESULTS:Thirty-nine infants fulfilled the hypothermia protocol criteria. Four newborns were removed from study due to refractory septic shock, non-maintenance of temperature and severe coagulopathy. The median Apgar scores at 1 and 5 minutes were 2 and 5. The main complication was infection, diagnosed in seven mothers (20%) and 14 newborns (40%). Convulsions occurred in 15 infants (43%). Thirty-one patients (88.6%) required mechanical ventilation and 14 of them (45%) were extubated within 24 hours. The duration of mechanical ventilation among the others was 7.7 days. The cooling protocol was started 1.8 hours after birth. All patients showed elevated levels of creatine phosphokinase, creatine phosphokinase- MB and lactate dehydrogenase. There was no severe arrhythmia; one newborn (2.9%) presented controlled coagulopathy. Four patients (11.4%) presented controlled hypotension. Twenty-nine patients (82.9%) underwent cerebral ultrasonography and 10 of them (34.5%) presented white matter hyper-echogenicity. Brain magnetic resonance imaging was performed on 33 infants (94.3%) and 11 of them (33.3%) presented hypoxic-ischemic changes. The hospital stay was 23 days. All newborns were discharged. Two patients (5.8%) needed gastrostomy.CONCLUSION:Hypothermia as therapy for asphyxiated newborns was shown to be safe.

CONTEXTO E OBJETIVO:A encefalopatia hipóxico-isquêmica neonatal apresenta alta morbi-mortalidade. Estudos com hipotermia comprovam diminuição de sequelas neurológicas e morte. Nosso objetivo foi então relatar experiência de três anos da hipotermia terapêutica em recém-nascidos (RN) asfixiados.TIPO DE ESTUDO E LOCAL:Estudo restrospectivo, conduzido em hospital universitário.MÉTODOS:Trinta e cinco pacientes com asfixia perinatal submetidos a resfriamento corporal entre maio de 2009 e novembro de 2012 foram avaliados.RESULTADOS:Trinta e nove RN preencheram os critérios do protocolo de hipotermia. Quatro RN foram excluídos devido a choque séptico refratário, não manutenção da temperatura e coagulopatia grave. A mediana do Apgar de 1 e 5 minutos foi de 2 e 5. A maior complicação foi infecção, diagnosticada em sete mães (20%) e 14 RN (40%). Convulsão ocorreu em 15 RN (43%). 31 pacientes (88,6%) necessitaram da ventilação mecânica e 14 (45%) foram extubados em 24 horas. O tempo de ventilação mecânica dos demais foi de 7,7 dias. O início do resfriamento ocorreu com 1,8 horas de vida. Todos os pacientes apresentaram níveis elevados de creatinofosfoquinase, creatinofosfoquinase-MB e desidrogenase lática. Não se observou arritmia grave; um RN (2,9%) apresentou coagulopatia controlada. Quatro pacientes (11,4%) tiveram hipotensão controlada. Realizou-se ultrassonografia cerebral em 29 pacientes (82,9%), 10 (34,5%) com hiperecogenicidade da substância branca. 33 RN (94,3%) fizeram ressonância magnética cerebral, 11 (33,3%) com alterações hipóxico-isquêmicas. O tempo de internação foi de 23 dias e todos receberam alta. Dois pacientes (5,8%) necessitaram de gastrostomia.CONCLUSÃO:A hipotermia como terapêutica para RN asfixiados demonstrou ser segura.

Factores pronósticos en adultos hospitalizados por neumonía causada por Legionella pneumophila / Prognostic factors in adult patients hospitalized for pneumonia caused by Legionella pneumophila

Introduction: Legionellosis is a multisystem bacterial disease, which causes pneumonia with high mortality in patients with comorbidity and admitted in intensive care units (ICU). Objective: Determine predictors of mortality or ICU admission. Methods: Retrospective follow-up of patients diagnosed with Legionella pneumophila pneumonia in Complexo Hospitalario Universitario de A Coruña. Period 2000-2013 (n = 240). Analysis of multivariate logistic regression was performed. Results: Mean age was 57.2 ± 15.4 years old, 88.3% were male. Average score of comorbidity (Charlson score) was 2.3 ± 2.3. There was a clear seasonal variation. Predominant symptoms were fever (92.5%), dry cough (38.1%) and dyspnea (33.9%). Creatinine clearance was lower than 60 mL/min/1.73 m² in 29.7% and sodium < 135 mEq/l in 58.3%. Admission to ICU rate was 16.3% and 10.8% needs mechanical ventilation. Inhospital mortality rate was 4.6%, rising to 23.1% in patients admitted to ICU. Variables associated to predict ICU admission were age (OR = 0.96), liver disease (OR = 7.13), dyspnea (OR = 4.33), delirium (OR = 5.86) and high levels of lactatedehydrogenase (OR = 1.002). Variables associated with inhospital mortality were Charlson index (OR = 1.70), mechanical ventilation (OR = 31.44) and high levels of lactatedehydrogenase (OR = 1.002). Discussion: Younger patients with liver disease, dyspnea and confusion are more likely to be admitted to ICU. Comorbidity, mechanical ventilation and elevated LDH levels are associated with higher mortality rate.

Introducción: La legionelosis es una enfermedad bacteriana multisistémica, causante de neumonías con mortalidad elevada en pacientes con comorbilidad e ingresos en Unidad de Cuidados Intensivos (UCI). Objetivo: Determinar factores pronósticos de mortalidad o ingreso en UCI. Material y Métodos: Estudio de seguimiento retrospectivo de pacientes diagnosticados de neumonía por Legionella pneumophila en Complexo Hospitalario Universitario de A Coruña (España). Período 2000-2013 (n = 240), con análisis de regresión logística multivariada. Resultados: La edad media fue 57,2 ± 15,4 años, 88,3% fueron hombres. La puntuación media de comorbilidad (score Charlson) fue 2,3 ± 2,3. Existe clara estacionalidad. La clínica predominante fue fiebre (92,5%), tos seca (38,1%) y disnea (33,9%). El 29,7% presentó aclaramiento de creatinina < 60 mL/min/1,73 m² y el 58,3% sodio < 135 mEq/l. Un 16,3% ingresó en UCI, precisando ventilación mecánica invasiva el 10,8%. La mortalidad global fue 4,6% y de 23,1% en ingresados en UCI. Variables asociadas para predecir ingreso en UCI fueron menor edad (OR = 0,96), hepatopatía (OR = 7,13), disnea (OR = 4,33), síndrome confusional (OR = 5,86) y lactato deshidrogenasa elevada (OR = 1,002). Las variables asociadas a mortalidad intrahospitalaria fueron índice de Charlson (OR = 1,70), ventilación mecánica invasiva (OR = 31,44) y cifras elevadas de lactato deshidrogenasa (OR = 1,002). Discusión: Pacientes jóvenes, con hepatopatía, disnea o confusión tienen más probabilidad de ingresar en UCI. Comorbilidad, ventilación mecánica y lactato deshidrogenasa elevada se asocian a mortalidad.

Role of frontline autologous stem cell transplantation in young, high-risk diffuse large B-cell lymphoma patients

BACKGROUND/AIMS: Several studies have demonstrated the effect of autologous hematopoietic stem cell transplantation (auto-HSCT) as a salvage treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL). However, the role of auto-HSCT as a frontline treatment has not been fully investigated in the rituximab era. We validated the age-adjusted International Prognostic Index (aaIPI) score for high-risk DLBCL patients and identified a possible role for frontline auto-HSCT. METHODS: We recommended frontline auto-HSCT for high-risk DLBCL patients who satisfied the criteria of both a higher Ann-Arbor stage (III to IV) and an elevated lactate dehydrogenase (LDH) level at diagnosis with an aaIPI score > or = 2. From 2006 to 2011, among the 150 DLBCL patients aged or = 2 showed inferior overall survival (OS; p = 0.040) and progression-free survival (PFS; p = 0.007) compared to the aaIPI score 0 to 1. Between the two treatment arms among the high-risk DLBCL patients, the clinical parameters were not different. The high-risk group treated with frontline auto-HSCT showed similar OS (p = 0.392) and PFS (p = 0.670) to those in the low-risk group. Thus, frontline auto-HSCT showed superior PFS (p = 0.004), but only a trend towards favorable OS (p = 0.091) compared to R-CHOP alone. CONCLUSIONS: We identified the possible role of frontline auto-HSCT for high-risk DLBCL with a higher stage (III to IV) and elevated LDH level.

A Comparison of the Bleaching Effectiveness of Chlorine Dioxide and Hydrogen Peroxide on Dental Composite

This study was carried out to verify if composites could be bleached using chlorine dioxide as compared with hydrogen peroxide. 3M ESPE Filtek Z350 Universal Restorative discs were prepared (n=40), with dimensions 5 mm diameter x 2 mm thickness. The discs were divided into 4 groups of 10 discs each. Color assessment was performed by CIEDE2000. The discs were stained with coffee, tea, wine and distilled water (control) solutions for 14 days, 5 hours daily. Color assessment was repeated on stained discs and followed by bleaching of 5 discs from each group using chlorine dioxide and hydrogen peroxide in-office systems. Finally, a last color assessment was performed and compared statistically. DE2000 after bleaching was very close to baseline for both the bleaching agents, although chlorine dioxide showed better results than hydrogen peroxide. After staining, there was a clinically significant discoloration (∆E2000≥3.43) for the tea, coffee and wine groups, and discoloration (∆E2000) was seen more in the wine group as compared to tea and coffee. Overall, the control group (distilled water) had the least color change in the three intervals. After bleaching, the color in all specimens returned close to the baseline. The color differences between bleaching and baseline were less than 3.43 for all groups. The obtained results show that chlorine dioxide is slightly superior to hydrogen peroxide in the bleaching of composites, while maintaining the shade of the composite close to the baseline.

Este estudo foi realizado para verificar se resinas compostas podem ser clareadas com uso do dióxido de cloro, em comparação com peróxido de hidrogênio. Foram preparados discos com resina restauradora Filtek Z350 3M ESPE (n=40), com dimensões 5 mm de diâmetro × 2 mm de espessura. Os discos foram divididos em 4 grupos de 10 discos cada. A avaliação da cor foi realizada por meio do CIEDE2000. Os discos foram manchados com soluções de café, chá, vinho e água destilada (controle) por 5 h diárias durante 14 dias. A avaliação da cor foi repetida nos discos manchados e seguida por clareamento de 5 discos de cada grupo, utilizando dióxido de cloro ou peróxido de hidrogênio pela técnica de consultório. Finalmente, uma última avaliação da cor foi realizada e as técnicas comparadas estatisticamente. DE2000 após o clareamento foi muito próxima ao baseline, para ambos os agentes clareadores, embora o dióxido de cloro tenha mostrado melhores resultados do que o peróxido de hidrogênio. Após o manchamento, houve uma descoloração clinicamente significativa (ΔE2000≥3,43) para os grupos de chá, café e vinho, sendo que o clareamento (ΔE2000) foi melhor obtido com o grupo do vinho, em comparação com chá e café. No geral, o grupo controle (água destilada) teve a menor mudança de cor nos três intervalos. Após o clareamento, a cor em todos os espécimes voltou próxima ao baseline. As diferenças de cor entre o clareamento e o baseline foram inferiores a 3,43 para todos os grupos. Os resultados indicam que o dióxido de cloro é ligeiramente superior ao peróxido de hidrogênio no clareamento de resinas compostas, mantendo a cor próxima à escala do baseline.

Clinical evaluation of the Spiral Pump® after improvements to the original project in patients submitted to cardiac surgeries with cardiopulmonary bypass / Avaliação clínica da bomba espiral (Spiral Pump®) após aperfeiçoamentos introduzidos ao projeto original em pacientes submetidos a cirurgias cardíacas com circulação extracorpórea

Objective: The objective of this paper is to present the results from Spiral Pump clinical trial after design modifications performed at its previous project. This pump applies axial end centrifugal hydraulic effects for blood pumping during cardiopulmonary bypass for patients under cardiac surgery. Methods: This study was performed in 52 patients (51% males), between 20 to 80 (67±14.4) years old weighing 53 to 102 (71.7±12.6) kg, mostly under myocardial revascularization surgery (34.6%) and valvular surgery (32.8%). Besides the routine evaluation of the data observed in these cases, we monitored pump rotational speed, blood flow, cardiopulmonary bypass duration, urine free hemoglobin for blood cell trauma analysis (+ to 4+), lactate desidrogenase (UI/L), fibrinogen level (mg/dL) and platelet count (nº/mm3). Results: Besides maintaining appropriate blood pressure and metabolic parameters it was also observed that the Free Hemoglobin levels remained normal, with a slight increase after 90 minutes of cardiopulmonary bypass. The Lactate Dehydrogenase showed an increase, with medians varying between 550-770 IU/L, whereas the decrease in Fibrinogen showed medians of 130-100 mg/dl. The number of platelets showed a slight decrease with the medians ranging from 240,000 to 200,000/mm3. No difficulty was observed during perfusion terminations, nor were there any immediate deaths, and all patients except one, were discharged in good condition. CONCLUSION: The Spiral Pump, as blood propeller during cardiopulmonary bypass, demonstrated to be reliable and safe, comprising in a good option as original and national product for this kind of application. .

Objetivos: Apresentar resultados da aplicação da bomba espiral que emprega efeitos hidráulicos centrífugo e axial de bombeamento como elemento propulsor do circuito de circulação extracorpórea em pacientes submetidos a cirurgias cardíacas após modificações introduzidas no design do projeto original. Métodos: O estudo foi realizado em 52 pacientes (51% masculinos), com idade entre 20 a 80 (67±14,4) anos, peso 53 a 102 (71,7±12,6) kg, submetidos na maioria a cirurgia de revascularização miocárdica (34,6%) e Orovalvar (32,8%). Além das avaliações rotineiras, foram registrados rotação, tempo de CEC e para análise do impacto traumático à crase sanguínea, hemoglobina livre na urina (+ a 4+), desidrogenase láctica, fibrinogênio (mg/dL) e contagem de plaquetas (nº/mm3). Resultados: Observou-se a manutenção de parâmetros pressóricos e metabólicos adequados. Quanto aos marcadores de danos à crase sanguínea, as alterações estiveram proporcionais ao tempo maior de circulação extracorpórea. Os níveis de Hemoglobina Livre permaneceram com valores normais, com ligeiro aumento a partir dos 90 minutos de circulação extracorpórea. A Desidrogenase Láctica mostrou aumento, variando as medianas entre 550 a 770 UI/L enquanto o Fibrinogênio mostrou queda das medianas de 130 a 100 mg/dl. O número de plaquetas mostrou ligeira queda das medianas variando entre 240.000 a 200.000/mm3. Não ocorreram dificuldades de saída de perfusão, não se observou óbito imediato e todos os pacientes, exceto 1, obtiveram alta hospitalar. Conclusão: A bomba espiral aplicada como bomba propulsora de sangue durante cirurgia cardíaca se mostrou confiável e segura, não causou impacto traumático ...

Atividade sérica das enzimas musculares em muares submetidos à prova de resistência de 100 km / Serum activity of muscular enzymes in mules after a 100 km endurance exercise

O presente estudo teve por objetivo avaliar a influência do exercício físico de intensidade submáxima sobre as concentrações séricas de aspartato aminotransferase (AST), creatinoquinase (CK) e lactato-desidrogenase (LDH) em muares durante prova de enduro de 100 km realizada no estado do Espírito Santo. Para tal foram obtidas amostras de soro de 20 muares em três momentos assim definidos: no repouso (T0); após 54 km de percurso (T1); após 80 km de percurso (T2); e após 100 km de percurso (T3). As referidas amostras foram encaminhadas ao Laboratório Clínico Veterinário (CEMEVES) para processamento. Na avaliação da atividade sérica de AST, os valores médios registrados nos momentos T0, T1, T2 e T3 foram, respectivamente, de 341,7±73,9 UI/L, 403,1±78,4 UI/L, 410,5±70,5 UI/L e 426,5±66,7 UI/L. Na avaliação da atividade sérica da LDH, os valores médios registrados foram de 423,1±101,8 UI/L, 534,4±131,8 UI/L, 628,5±100,6 UI/L e 823,4±273,2 UI/L, respectivamente, nos momentos T0, T1, T2 e T3. Por fim, na avaliação da atividade sérica da CK os valores de mediana foram de 231,3 UI/L, 310,6 UI/L, 253,2 UI/L e 476,0 UI/L, respectivamente nos momentos T0, T1, T2 e T3. A análise dos resultados demonstrou que o exercício físico imposto levou ao aumento significativo das atividades séricas de AST e LDH e não alterou as concentrações séricas de CK.

The aim of this study was to evaluate the influence of an exercise of submaximal intensity on serum concentrations of aspartate aminotransferase (AST), creatine kinase (CK) and lactate dehydrogenase (LDH) in mules during endurance exercise in Espirito Santo, Brazil. Serum samples were obtained from 20 mules in four different moments: at rest (T0); after 54 km (T1); after 80 km (T2); and after 100 km (T3). Samples were analyzed at Laboratório Clínico Veterinário (CEMEVES). Serum AST analysis revealed mean values of 341.7±73.9 UI/L, 403.1±78.4 UI/L, 410.5±70.5 UI/L and 426.5±66.7 UI/L, respectively at moments T0, T1, T2 and T3. LDH mean values recorded in T0, T1, T2 and T3 were, respectively, 423.1±101.8 UI/L, 534.4±131.8 UI/L, 628.5±100.6 UI/L and 823.4±273.2 UI/L. Finally, when evaluating CK, median values recorded were 231.3 UI/L, 310.6 UI/L, 253.2 UI/L and 476.0 UI/L, respectively on the moments T0, T1, T2 and T3. Results showed that the physical exercise imposed leaded to significantly increase in serum AST and LDH and did not change serum CK.

Alteraciones bioquímicas como marcadores predictores de gravedad en pacientes con fiebre por dengue / Biochemical alterations as prediction markers for the severity of illness in dengue fever patients

Introducción. El dengue es la infección transmitida por mosquitos más importante en el mundo. Existe información de que las alteraciones bioquímicas pueden utilizarse como herramientas predictoras de gravedad del dengue. Objetivo. Evaluar las alteraciones bioquímicas como posibles marcadores predictores de gravedad del dengue. Materiales y métodos. Se llevó a cabo un estudio de casos y controles anidado en una cohorte. Se seleccionaron al azar 125 casos con dengue grave y 120 controles con dengue no grave para evaluar los niveles séricos de lactato-deshidrogenasa (LDH), creatina cinasa (CK), proteína C reactiva (PCR) y albúmina, en sueros obtenidos en las primeras horas de la enfermedad. Para evaluar el valor diagnóstico de cada biomarcador, se establecieron puntos de corte con una sensibilidad del 90 % en la detección de casos graves. Resultados. Se observó una asociación entre los niveles de PCR por debajo de 9,8 mg/l (OR=0,04; IC 95% =0,02-0,08 ; p=0,000), de LDH inferiores a 400 U/L (OR=0,49; IC 95% =0,24-1,02; p=0,053) y de albúmina menor de 4 mg/dl (OR=3,46; IC 95% =1,96-6,12; p=0,000), con la gravedad del dengue. En contraste, los niveles de la CK no mostraron asociación con la gravedad de la enfermedad. Conclusiones. Los hallazgos de nuestro estudio sugieren una asociación de los niveles de PCR, LDH y albúmina con la gravedad del dengue. Estas pruebas bioquímicas podrían ser utilizadas como herramientas predictoras del curso clínico de la infección.

Introduction: Dengue is the most important mosquito-borne infection in the world. There is evidence supporting the use of biochemical alterations as prediction tools for severity of illness in dengue. Objective: To evaluate biochemical alterations as potential prediction markers for severity in dengue. Materials and methods: This was a case-control study nested in a cohort. We randomly selected 125 severe dengue cases and 120 controls with non-severe dengue for measuring LDH, CK, CRP and albumin serum levels using acute phase sera. To evaluate the predictive value for each biomarker, we established cut-off points with 90% sensitivity in detecting severe cases. Results: There was association among the CRP levels < 9.8 mg/L (OR=0.04; 95%CI=0.02-0.08; p=0.000), <400 U/L LDH levels (OR=0.49; 95%CI=0.24-1.02; p=0.053) and <4 mg/dl albumin levels (OR=3.46; 95%CI=1.96-6.12; p=0.000) with the severity of dengue. In contrast, the CK levels showed no association with the severity of the disease. Conclusions: Our findings suggest an association of CRP, LDH and albumin levels with the severity of dengue. These biochemical tests could be used as predictive tools in the clinical course of the infection.