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1.
Rev. medica electron ; 43(1): 2873-2886, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156781

ABSTRACT

RESUMEN Introducción: las lesiones traumáticas del anillo pélvico constituyen un desafío para los cirujanos ortopedistas por su alta morbimortalidad y las consecuencias que de ellas derivan. Objetivo: describir el comportamiento de variables demográficas y clínicas en los pacientes atendidos por lesiones traumáticas del anillo pélvico en el Hospital Universitario "Comandante Faustino Pérez Hernández" de Matanzas Materiales y Métodos: se realizó un estudio longitudinal prospectivo descriptivo de los pacientes ingresados en el servicio de ortopedia y traumatología por presentar lesiones traumáticas del anillo pélvico en dicho centro en el período comprendido de enero del 2009 a enero del 2019. Se seleccionaron variables demográficas y clínicas Resultados: el estudio incluyó a 48 pacientes. Predominó el sexo masculino 29 pacientes para un 60,4%, la edad de mayor frecuencia estuvo entre 31 a 50 años. Predominaron las fracturas tipo B con 24 pacientes para 50% y el tratamiento quirúrgico con 27 pacientes para 56,2%, dentro de las complicaciones inmediatas predominó el shock hipovolémico en 14 pacientes para 29.1%, en las tardías la sepsis superficial con 6 pacientes, 12.5%. Conclusiones: las lesiones traumáticas del anillo pélvico siempre deben ser tratadas como lesiones graves, por lo que deben ser valoradas de forma multidisciplinaria y apegados a protocolos de actuación, y con especialistas de alta experiencia profesional (AU).


SUMMARY Introduction: pelvic ring traumatic lesions are a challenge for orthopedic surgeons due to their high morbi-mortality and the consequences derived from them. Objective: to describe the behavior of clinical and demographic variables in patients cared due to pelvic ring traumatic lesions in the University Hospital "Comandante Faustino Perez Hernandez" of Matanzas. Method: a descriptive, prospective, longitudinal research was carried out in patients admitted to the Orthopedics and Traumatology Service of the before-named hospital for presenting pelvic ring traumatic lesions in the period from January 2009 until January 2019. Clinical and demographic variables were chosen. Results: the study included 48 patients. Male sex predominated, 29 patients, 60.4 %; the most frequent age ranged between 31 and 50 years. Type B fractures predominated with 24 patients and 50 %; surgical treatment also predominated with 27 patients and 56.2 %; among the immediate complications, hypovolemic shock predominated in 14 patients for 29.1 %; among the late ones, surface sepsis predominated with 6 patients, 12.5 %. Conclusions: pelvic ring traumatic lesions should be always treated like serious lesions; therefore they should be evaluated in a multidiscipline way, adhered to the intervention protocols, and by highly experienced professionals (AU).


Subject(s)
Humans , Pelvis/injuries , Shock/etiology , Wounds and Injuries/epidemiology , Sepsis/etiology , Pelvis/surgery , Wounds and Injuries/mortality , Indicators of Morbidity and Mortality , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
2.
Rev. medica electron ; 43(1): 2887-2902, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156782

ABSTRACT

RESUMEN Introducción: los tumores de la encrucijada duodeno-bilio-pancreática o periampulares corresponden a un grupo heterogéneo de tumores. Se originan dentro de los 2 cm de la papila duodenal mayor. En los tumores irresecables, el tratamiento debe estar dirigido a la paliación más efectiva. El tratamiento quirúrgico paliativo va dirigido a resolver la obstrucción biliar, duodenal y el dolor, con el fin de optimizar la calidad de vida de los pacientes. Objetivo: describir el comportamiento del tratamiento quirúrgico paliativo de los tumores periampulares. Materiales y métodos: se realizó una investigación observacional, descriptiva y prospectiva con los pacientes con tumor periampular irresecable tributarios a tratamiento quirúrgico paliativo, en el Servicio de Cirugía General del Hospital Universitario "Comandante Faustino Pérez Hernández", en la ciudad de Matanzas, desde enero del 2010 hasta diciembre del 2019. Resultados: el tumor de páncreas fue el más representado. Todos los pacientes fueron tributarios de derivación biliar quirúrgica paliativa, sin embargo, la derivación gástrica se realizó solo con confirmación endoscópica de infiltración tumoral u obstrucción duodenal y la esplacnicectomía química, siempre que fue factible técnicamente o las condiciones del paciente lo permitieron. La hepaticoyeyunostomía en Y de ROUX fue la derivación biliar de elección. La principal complicación quirúrgica fue la sepsis provocando las muertes. Conclusiones: la paliación quirúrgica es la alternativa de elección con mejores resultados a largo plazo, en los tumores periampulares irresecables con buen estado general, lo que contribuye a una mejor calidad de vida (AU).


ABSTRACT Introduction: the tumors of the duodenal-biliary-pancreatic junction or periampullary tumors correspond to a heterogeneous group of tumor. They originate inside the 2 cm of the major duodenal papilla. In unresectable tumors, the treatment should be intended for the most effective palliation. The surgical palliative treatment is intended for solving biliary, duodenal obstruction, and pain, with the aim of optimizing patients' life quality. Objective: to describe the behavior of the periampullary tumors palliative surgical treatment. Materials and methods: a prospective, descriptive, observational research was carried out in patients with unresectable periampullary tumor tributary to palliative surgical treatment, in the Service of General Surgery of the University Hospital "Comandante Faustino Perez Hernandez", of Matanzas, from January 2010 to December 2019. Results: pancreas tumor was the most represented one. All patients were tributary to biliary palliative surgical derivation, however, gastric derivation was performed only with endoscopic confirmation of tumor infiltration or duodenal obstruction, and chemical splanchnicectomy whenever it was technically feasible and the patient's conditions allowed it. Roux's Y-shaped hepaticojejunostomy was the elective biliary derivation. The main surgical complication was sepsis provoking deaths. Conclusions: surgical palliation is the election alternative with long- term better outcomes, in unresectable periampullary tumors with a good general status, contributing to better life quality (AU).


Subject(s)
Humans , Pancreatic Neoplasms/surgery , Biliopancreatic Diversion , Sepsis/etiology , Duodenal Obstruction , Cancer Pain , Pancreatic Neoplasms/complications , Quality of Life , Epidemiology, Descriptive , Prospective Studies , Observational Study
3.
Autops. Case Rep ; 11: e2020237, 2021. graf
Article in English | LILACS | ID: biblio-1153177

ABSTRACT

Whipple's Disease, a rare diagnosis caused by the slow-growing bacterium Tropheryma whipplei, most often presents with the classically described signs of malabsorption due to gastrointestinal colonization. However, it can also have signs and symptoms that clinically overlap with rheumatic diseases, potentially resulting in misdiagnosis. Furthermore, treatment with modern potent biologic immunosuppressive agents and classic disease modifying anti-rheumatic drugs (DMARDs) can lead to serious exacerbation of undiagnosed infections. We present the case of a middle-aged woman with long term complaints of arthalgias, who was diagnosed with seronegative rheumatoid arthritis and subsequently treated for almost 7 years with such immunosuppressive therapies. The patient's disease course included chronic diarrhea that abruptly intensified and culminated in fatal hypovolemic shock/sepsis. A diagnosis of WD was made by autopsy examination, wherein several organ systems were found to be heavily involved by Tropheryma whipplei organisms, and their identification was confirmed with histochemical and molecular evaluation. Notably, most bacterial organisms were located deeply in the submucosa/muscularis of affected organs, a practical reminder to practicing pathologists that challenges the classic histopathologic description of Whipple disease as an infiltration of predominantly lamina propria, and the potential for sampling bias in typically superficial endoscopic biopsies during routine procedures.


Subject(s)
Humans , Female , Middle Aged , Actinomycetales Infections/pathology , Tropheryma , Whipple Disease/complications , Whipple Disease/pathology , Autopsy , Rheumatic Diseases/complications , Sepsis/etiology , Diagnostic Errors/prevention & control
4.
Rev. chil. obstet. ginecol. (En línea) ; 85(3): 275-280, jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1126163

ABSTRACT

RESUMEN Presentamos caso clínico de puérpera de cesárea de noveno día con cuadro febril en espigas, asintomática, en que se plantea desde su ingreso el diagnóstico de tromboflebitis séptica pelviana y se inicia tratamiento con antibióticos parenterales de amplio espectro y heparina de bajo peso molecular en dosis terapéuticas. La respuesta es a la mejoría al tercer día de tratamiento. Se discuten los métodos diagnósticos, el diagnóstico diferencial y el tratamiento.


ABSTRACT A case of a woman on her 9th post-operative day after childbirth by cesarean section (CS) consulting with febrile spikes, otherwise asymptomatic, is presented. The diagnosis of a septic pelvic thrombophlebitis is proposed from the admission and treated with parenteral broad-spectrum antibiotics and low-molecular-weight heparin at therapeutic doses. Patient significantly improved on her third day of treatment. The diagnostic procedures, differential diagnosis and treatment are discussed.


Subject(s)
Humans , Female , Adult , Ovary/blood supply , Thrombophlebitis/etiology , Cesarean Section/adverse effects , Sepsis/etiology , Pelvis/blood supply , Thrombophlebitis/drug therapy , Thrombophlebitis/diagnostic imaging , Heparin/therapeutic use , Tomography, X-Ray Computed , Sepsis/drug therapy , Sepsis/diagnostic imaging , Diagnosis, Differential , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use
5.
Rev. bras. ter. intensiva ; 32(1): 2-10, jan.-mar. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138470

ABSTRACT

RESUMO A atual epidemia de COVID-19 foi declarada em 31 de dezembro de 2019 no mercado de frutos do mar da cidade de Wuhan, com rápida disseminação na China e, posteriormente, envolvendo múltiplos países (como maior expressão na Coreia do Sul, Japão, Itália e Irã) incluindo, desde 1º de março, Portugal. A maioria dos doentes infetados apresenta doença ligeira sem necessidade de hospitalização. Dentre os internados, de 6% a 10% necessitam de cuidados intensivos. As presentes recomendações visam facilitar a organização dos serviços de medicina intensiva para a resposta ao COVID-19, proporcionado os melhores cuidados aos doentes e protegendo os profissionais de saúde.


ABSTRACT Current COVID-19 epidemics was declared on December 31, 2019 at the Wuhan city seafood market, rapidly spreading throughout China, and later reaching several countries (mainly South Korea, Japan, Italy and Iran) and, since March 1, reaching Portugal. Most of the infected patients present with mild symptoms, not requiring hospitalization. Among those admitted to the hospital, 6% to 10% require admission to the intensive care unit. These recommendations are aimed to support the organization of intensive care services to respond COVID-19, providing optimized care to the patient and protection for healthcare professionals.


Subject(s)
Humans , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Coronavirus Infections/complications , Coronavirus Infections/therapy , Pandemics , Intensive Care Units , Portugal , Practice Guidelines as Topic , Sepsis/etiology , Sepsis/therapy , Critical Care/methods , Betacoronavirus , SARS-CoV-2 , COVID-19 , Hospitalization
6.
Rev. cuba. cir ; 58(4): e860, oct.-dic. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126390

ABSTRACT

RESUMEN Introducción: La determinación del pronóstico del paciente con peritonitis difusa secundaria es un reto para cirujanos e intensivistas. Objetivo: Identificar los factores relacionados con el riesgo de falla multiorgánica en pacientes con peritonitis difusa secundaria ingresados en la unidad de terapia intensiva del Hospital "Dr. Agostinho Neto". Métodos: Se realizó un estudio de casos (pacientes con peritonitis y falla multiorgánica n = 68) y controles (pacientes con peritonitis sin falla multiorgánica n = 47), en el periodo de 2017-2018. Se analizaron 64 variables que caracterizaron al paciente o a la peritonitis, y se calculó su asociación con el riesgo del paciente para presentar falla multiorgánica. Resultados: Las variables más asociadas a este riesgo fueron: riesgo anestésico 3 o más según la clasificación de la Sociedad Americana de Anestesia (odds ratio = 47,7), desequilibrio ácido-básico/ electrolítico (odds ratio = 22,6), hiperglucemia de 10 mmol/l o más en no diabéticos (odds ratio = 15,5), íleo paralítico reflejo persistente (odds ratio = 13,6), distrés respiratorio (odds ratio = 11,8), uso de ventilación mecánica invasiva (odds ratio = 11,8), Sequential [Sepsis-Related] Organ Failure Assessment 4 puntos o más (odds ratio = 10,2), tratamiento con abdomen abierto (odds ratio =9,0), escala Acute Physiology and Chronic Health Evaluation II 15 puntos o más (odds ratio = 8,9), shock séptico (odds ratio = 8,6). Conclusiones: Se identificaron los factores asociados a la presentación de falla multiorgánica, lo que hizo posible el diseño de una escala predictiva de esta falla en el paciente con peritonitis difusa secundaria(AU)


ABSTRACT Introduction: Determining the prognosis of the patient with secondary diffuse peritonitis is a challenge for surgeons and intensivists. Objective: To identify the factors related to the risk of multiple organ failure in patients with secondary diffuse peritonitis admitted to the intensive care unit of the Hospital "Dr. Agostinho Neto". Methods: A case study (patients with peritonitis and multi-organ failure n = 68) and controls (patients with peritonitis without multi-organ failure n = 47), in the period 2017-2018, was performed. 64 variables that characterized the patient or peritonitis were analyzed, and their association with the risk of the patient to present multiple organ failure was calculated. Results: The variables most associated with this risk were: anesthetic risk 3 or more according to the American Society of Anesthesia classification (odds ratio = 47.7), acid-basic / electrolyte imbalance (odds ratio = 22.6), hyperglycemia 10 mmol / l or more in non-diabetics (odds ratio = 15.5), persistent reflex paralytic ileus (odds ratio = 13.6), respiratory distress (odds ratio = 11.8), use of invasive mechanical ventilation (odds ratio = 11.8), Sequential [Sepsis-Related] Organ Failure Assessment 4 points or more (odds ratio = 10.2), treatment with open abdomen (odds ratio = 9.0), Acute Physiology and Chronic Health Evaluation II scale 15 15 points or more (odds ratio = 8.9), septic shock (odds ratio = 8.6). Conclusions: The factors associated with the presentation of multi-organ failure were identified, which made possible the design of a predictive scale of this failure in the patient with secondary diffuse peritonitis(AU)


Subject(s)
Humans , Peritonitis/diagnosis , Intensive Care Units , Multiple Organ Failure/etiology , Case-Control Studies , Sepsis/etiology
7.
Rev. bras. ter. intensiva ; 31(3): 368-378, jul.-set. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1042582

ABSTRACT

RESUMO A sepse persiste como importante sobrecarga à saúde pública nos Estados Unidos e em todo o mundo. Com o crescente uso de tecnologias laboratoriais, tem se renovado o interesse na utilização de biomarcadores na sepse, para auxiliar em um processo mais preciso e direcionado para tomadas de decisão. Os peptídeos natriuréticos vem sendo cada vez mais reconhecidos por seu papel que vai além da insuficiência cardíaca. Estes peptídeos estão comumente elevados em pacientes críticos que apresentam condições de disfunção cardiopulmonar e podem ter papel na identificação de pacientes com sepse e choque séptico. São poucos os dados disponíveis em relação ao papel destes biomarcadores no diagnóstico, no controle, nos desfechos e no prognóstico de pacientes sépticos. Esta revisão procura descrever o papel dos peptídeos natriuréticos na ressuscitação volêmica, no diagnóstico de disfunção ventricular, nos desfechos e no prognóstico de pacientes com sepse. Tem sido observado que o peptídeo natriurético tipo B (BNP) e o fragmento N-terminal do peptídeo natriurético tipo B (NT-proBNP) se associam com disfunção ventricular sistólica e diastólica, tanto esquerda quanto direita, em pacientes com cardiomiopatia séptica. O BNP e o NT-proBNP podem predizer a responsividade a volume, e as tendências de medidas seriadas destes peptídeos podem ser importantes na ressuscitação volêmica. A despeito da sugestão de correlação com mortalidade, o papel do BNP nos desfechos de mortalidade e prognóstico, durante a sepse, ainda necessita melhor avaliação.


ABSTRACT Sepsis continues to be a leading public health burden in the United States and worldwide. With the increasing use of advanced laboratory technology, there is a renewed interest in the use of biomarkers in sepsis to aid in more precise and targeted decision-making. Natriuretic peptides have been increasingly recognized to play a role outside of heart failure. They are commonly elevated among critically ill patients in the setting of cardiopulmonary dysfunction and may play a role in identifying patients with sepsis and septic shock. There are limited data on the role of these biomarkers in the diagnosis, management, outcomes and prognosis of septic patients. This review seeks to describe the role of natriuretic peptides in fluid resuscitation, diagnosis of ventricular dysfunction and outcomes and the prognosis of patients with sepsis. B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have been noted to be associated with left ventricular systolic and diastolic and right ventricular dysfunction in patients with septic cardiomyopathy. BNP/NT-proBNP may predict fluid responsiveness, and trends of these peptides may play a role in fluid resuscitation. Despite suggestions of a correlation with mortality, the role of BNP in mortality outcomes and prognosis during sepsis needs further evaluation.


Subject(s)
Humans , Peptide Fragments/physiology , Sepsis/complications , Sepsis/etiology , Sepsis/mortality , Sepsis/therapy , Natriuretic Peptide, Brain/physiology , Prognosis , Shock, Septic/complications , Shock, Septic/etiology , Shock, Septic/mortality , Shock, Septic/therapy , Treatment Outcome , Ventricular Dysfunction, Left/etiology , Fluid Therapy
8.
Rev. argent. coloproctología ; 30(1): 27-37, mar. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1023695

ABSTRACT

Introducción: La ligadura con banda elástica es un procedimiento efectivo y de bajo costo, para el manejo de hemorroides grado I-III, que no requiere internación. Sus complicaciones, cuando presentes, son habitualmente leves. Aunque poco comunes, existen complicaciones graves asociadas a este procedimiento. El objetivo de este estudio es realizar una revisión de las complicaciones infecciosas pelvi-perineales de la ligadura con banda elástica, características comunes de presentación y alternativas de tratamiento en aquellos que sufren estas complicaciones. Descripción del caso: Se expone el caso de un hombre de 71 años de edad que presentó una sepsis pelviana severa posterior a la realización de una ligadura con banda elástica. A las 48 horas del procedimiento consulta por dolor perianal, dificultad miccional y fiebre. Se realiza el drenaje quirúrgico de ambas fosas isquiorrectales, luego de lo cual intercurre con shock séptico, realizándose una laparotomía, drenaje de retroperitoneo, colostomía sigmoidea. Posteriormente, debido al desarrollo de un síndrome compartimental abdominal, el abdomen se dejó abierto y contenido con una malla. Discusión: Se han descripto complicaciones sépticas posteriores a escleroterapia y crioterapia hemorroidal, ligadura con banda elástica, hemorroidectomia convencional y con sutura mecánica. Se exponen 20 casos de sepsis pelviana post-ligadura con banda elástica. La relación hombre:mujer fue de 3:1, con un amplio rango de edad (27-82 años). Sólo 2 tenían antecedentes de inmunosupresión. La progresión o la persistencia del dolor asociado a fiebre, dificultad miccional, edema perineal y/o genital fueron signos y síntomas comunes que se manifestaron dentro de los 14 días posteriores a la ligadura. Tal como en el caso aquí referido como en otros ya publicados, la realización de imágenes ayudó al diagnóstico y a la planificación quirúrgica. Todos recibieron antibioticoterapia de amplio espectro y 13 requirieron además cirugía. El espectro de tratamientos quirúrgicos fue desde el drenaje incisional hasta la amputación rectal. Ante la progresión del cuadro séptico, la realización de una ostomía fue la conducta más usual. Cinco pacientes requirieron más de una cirugía, y 8 fallecieron. Conclusión: Es importante conocer las complicaciones infecciosas mayores y su presentación clínica, para realizar un diagnóstico y tratamiento precoz de las mismas, con el fin de disminuir su elevada morbilidad o mortalidad. (AU)


Background: Rubber band ligation is an effective, low-cost procedure for grade I-III hemorrhoids, and does not require hospitalization. Its complications, when present, are usually mild. Although rare, there are serious complications associated with this procedure. The purpose of this review was to identify common presenting features and treatment alternatives in those who suffer pelviperineal infectious complications after rubber band ligation. Case Report: The present case is that of a 71-year-old man who presented severe pelvic sepsis after rubber band ligation. He complained of perianal pain, voiding difficulties and fever 48 hours after the procedure. Surgical drainage of both ischiorectal fossae was carried out. He developed septic shock. Laparotomy, retroperitoneal drainage and sigmoid loop colostomy were performed. In a subsequent operation due to abdominal compartment syndrome, the abdomen was left open and contained with a mesh. Discussion: Septic complications have been described after sclerotherapy, cryotherapy, rubber band ligation, conventional hemorrhoidectomy and stapled haemorrhoidopexy. We describe 20 cases of pelvic sepsis after rubber band ligation. The male: female ratio was 3: 1, with a wide age range (27- 82 years). Only 2 had a history of immunosuppression. The progression or persistence of pain associated with fever, voiding difficulties, perineal and / or genital edema were common signs and symptoms that appeared within 14 days after rubber band ligation. In the case here referred to as in others already published, imaging studies helped the diagnosis and surgical planning. All received broad spectrum antibiotic therapy and 13 required surgery. The spectrum of surgical treatments ranged from incisional drainage to rectal amputation. In view of the progression of the septic condition, performing an ostomy was the most usual conduct. Five patients required more than one surgery, and 8 died. Conclusion: It is important to acknowledge the major infectious complications and their clinical presentation, to help with an early diagnosis and treatment, in order to reduce their high morbidity and mortality. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Surgical Wound Infection/etiology , Sepsis/etiology , Hemorrhoids/surgery , Ligation/adverse effects , Ligation/methods , Rectal Diseases/surgery , Rectal Diseases/therapy , Reoperation , Surgical Wound Infection/therapy , Sepsis/therapy , Ligation/instrumentation , Anti-Bacterial Agents/therapeutic use
9.
Article in English | AIM, AIM | ID: biblio-1258703

ABSTRACT

Introduction :Sepsis is one of the leading causes of death worldwide. There is a paucity of data describing the epidemiology of sepsis in emergency centres in developing countries. This study aims to describe the clinical profile and management of patients presenting with sepsis in this setting.Methods:A retrospective chart review was conducted in an Emergency Centre (EC) of a district hospital in Durban from December 2015 to February 2016. All patients with a diagnosis of an infection that met the Surviving Sepsis Campaign criteria for sepsis syndrome were included in the study.Results:A total of 1195 patients who were diagnosed with an infection were screened. Of these, 52 of them met the inclusion criteria for the study. The criteria for severesepsis was met in 40.3% (n 23) and 1.9% (n 1) met the criteria for septic shock. More than half of the patients were HIV positive and 30.7% did not know their HIV status. The most common sites of infection were respiratory tract, gastrointestinal and central nervous system respectively. Most patients were admitted to the general medical ward. The inpatient mortality rate was 15% for general medical ward admissions.Conclusion:A better understanding of the demographic and clinical profile of sepsis syndrome in South African ECs is required to guide clinical and operational policy development


Subject(s)
Emergency Service, Hospital , Sepsis/diagnosis , Sepsis/epidemiology , Sepsis/etiology , South Africa
10.
Rev. bras. epidemiol ; 22(supl.3): e190012.supl.3, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1057821

ABSTRACT

RESUMO Introdução: A sepse representa a ocorrência de síndrome de resposta inflamatória sistêmica desencadeada por infecção inicial de um órgão ou sistema. Quando a sepse é atestada como causa do óbito, perde-se o primo diagnóstico, condicionando perda de informação quanto à sua origem. Objetivo: Analisar as causas básicas após investigação de óbitos por sepse em 60 municípios do Brasil em 2017. Metodologia: Foram selecionados todos os óbitos registrados em 2017 no Sistema de Informação sobre Mortalidade como sepse, e analisadas as proporções dos óbitos reclassificados após investigação em hospitais e outros serviços de saúde. Resultados: Entre os 6.486 óbitos por sepse ocorridos nos 60 municípios foram investigados 1.584 (24,4%) e, destes, 1.308 (82,6%) foram reclassificados com outras causas básicas. A faixa etária de 70 a 89 anos obteve a maior concentração de registros, com 49,3% dos casos. Mais de 60% dos óbitos por sepse reclassificados após investigação tiveram doenças crônicas não transmissíveis como causa básica (65,6%), sendo a diabetes a causa específica mais comum neste grupamento. Doenças transmissíveis (9,6%) e causas externas (5,6%) como quedas foram também detectadas como causas básicas. Conclusão: A partir das investigações dos óbitos por sepses foi possível conhecer a verdadeira causa de morte e as proporções de reclassificação. Essas informações contribuirão para melhorar a qualidade dos dados de mortalidade e para subsidiar o planejamento de ações em saúde pública no Brasil.


ABSTRACT Introduction: Sepsis represents the occurrence of systemic inflammatory response syndrome triggered by the initial infection of an organ or system. When sepsis is certified as the cause of death, the first diagnosis is lost, leading to inaccurate information as to its origin. Objective: To analyze the underlying causes of death from sepsis after investigation in 60 Brazilian municipalities in 2017. Methodology: All deaths recorded in the Mortality Information System (SIM) as sepsis in 2017 were selected, and the proportions of reclassified deaths were calculated based on the results of research conducted in hospitals and other health services. Results: Of the 6,486 deaths from sepsis that occurred in the 60 municipalities, 1,584 (24.4%) were investigated, and of these, 1,308 (82.6%) were reclassified with other underlying causes. Individuals aged from 70 to 89 years old showed the highest concentration in the records, with 49.3% of cases. More than 60% of the deaths from sepsis reclassified after the investigation had chronic non-communicable diseases as underlying causes (65.6%), with diabetes being the most common specific cause in this group. Communicable diseases (9.6%) and external causes (5.6%) such as falls were also detected as underlying causes. Conclusion: The investigation of deaths from sepsis made it possible to identify the true causes of death and the proportions of reclassification. This information will improve the quality of mortality data and support the planning of public health actions in Brazil.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Cause of Death , Sepsis/mortality , Brazil/epidemiology , Information Systems/standards , Death Certificates , Cities/epidemiology , Sex Distribution , Age Distribution , Sepsis/etiology , Geography , Middle Aged
11.
Rev. bras. ter. intensiva ; 30(4): 508-511, out.-dez. 2018. graf
Article in Spanish | LILACS | ID: biblio-977992

ABSTRACT

RESUMEN Existe poca evidencia que avale el uso de ventilación mecánica no invasiva en falla respiratoria aguda hipoxémica. Sin embargo, considerando las complicaciones asociadas a la intubación endotraqueal, se intentó implementar ventilación mecánica no invasiva en una paciente de 24 años cursando 32 semanas de gestación, que ingresó a la unidad de cuidados intensivos con falla respiratoria aguda hipoxémica y sepsis a foco urinario. La falta de tolerancia a la ventilación mecánica no invasiva, nos indujo a utilizar un método alternativo con el fin de evitar la intubación endotraqueal. La implementación de terapia con oxígeno a alto flujo a través de cánula nasal permitió superar la situación, presentando a ésta técnica como una opción de tratamiento en pacientes obstétricas críticas, segura tanto para la madre como para el feto.


ABSTRACT Little evidence exists to support the use of noninvasive mechanical ventilation for acute hypoxemic respiratory failure. However, considering the complications associated with endotracheal intubation, we attempted to implement noninvasive mechanical ventilation in a 24-year-old patient who was 32 weeks pregnant and was admitted to the intensive care unit with acute hypoxemic respiratory failure and sepsis secondary to a urinary tract infection. Lack of tolerance to noninvasive mechanical ventilation led us to use an alternative method to avoid endotracheal intubation. The use of high-flow nasal cannula allowed to overcome this situation, wich supports this technique as a treatment option for critical obstetric patients that is safe for both the mother and fetus.


Subject(s)
Humans , Female , Pregnancy , Young Adult , Pregnancy Complications/therapy , Respiratory Distress Syndrome/therapy , Noninvasive Ventilation/methods , Cannula , Pregnancy Complications/physiopathology , Urinary Tract Infections/complications , Sepsis/etiology , Sepsis/therapy , Intensive Care Units
12.
Medisan ; 21(12)dic. 2017. tab
Article in Spanish | LILACS | ID: biblio-894596

ABSTRACT

Se realizó un estudio descriptivo, longitudinal y prospectivo de 22 niños con quemaduras y evolución clínica hacia el síndrome de respuesta inflamatoria sistémica, ingresados en el Servicio de Caumatología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero del 2012 hasta diciembre del 2014, con vistas a caracterizarles según algunas variables clinicoepidemiológicas. En la casuística predominaron el grupo etario de 1-4 años (45,5 por ciento), el sexo femenino (59,1 por ciento), la taquicardia como criterio diagnóstico, las quemaduras hipodérmicas AB (77,3 por ciento) y el pronóstico de muy grave (31,8 por ciento). En todos los pacientes la causa de la aparición del síndrome de respuesta inflamatoria sistémica fue la destrucción tisular aguda; solo tres lesionados (13,6 por ciento) presentaron el síndrome por segunda vez debido a sepsis, de los cuales uno falleció por insuficiencia respiratoria y los otros dos por disfunción múltiple de órganos, luego de haberse manifestado la entidad clínica por tercera vez en estos últimos. Se concluyó que la edad, la relación superficie-profundidad de las quemaduras y el atraso en la reanimación con líquidos, pudieron repercutir en la aparición de dicho síndrome


A descriptive, longitudinal and prospective study of 22 children with burns and clinical course toward the systemic inflammatory response syndrome, admitted to the Caumatology Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital was carried out in Santiago de Cuba, from January, 2012 to December, 2014, aimed at characterizing them according to some clinical epidemiological variables. In the case material there was a prevalence of the 1-4 age group (45.5 percent), female sex (59.1 percent), tachycardia as diagnostic criterion, AB hypodermic burns (77.3 percent) and the very serious state prognosis (31.8 percent). In all the patients the cause of the systemic inflammatory response syndrome emergence was the acute tissue destruction; just three injured patients (13.6 percent) presented the syndrome for a second time due to sepsis, one of them died due to respiratory failure and the remaining two due to multiple organs dysfunction, after the clinical entity was manifested for a third time in these last two patients. It was concluded that the age, surface-depth relationship of the burns and the delay in liquids resuscitation, could have effects on the emergence of this syndrome


Subject(s)
Humans , Male , Female , Child , Burns/complications , Systemic Inflammatory Response Syndrome , Sepsis/etiology , Burn Units , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
13.
Arch. argent. pediatr ; 115(5): 311-314, oct. 2017. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-887384

ABSTRACT

Trichosporon asahii es un hongo ubicuo que se ha aislado como parte de la microbiota humana. Recientemente, se ha visto una emergencia de este patógeno en infecciones tanto localizadas como sistémicas. En unidades de cuidados intensivos pediátricos para quemados, existen escasos reportes de infecciones del tracto urinario por este microorganismo. Se describen 2 pacientes pediátricos con internación prolongada por quemaduras extensas y múltiples tratamientos antibióticos previos. Ambos presentaron sepsis por infección del tracto urinario asociada a sonda vesical por Trichosporon asahii. En ambos pacientes, se realizó el recambio de la sonda vesical y tratamiento con voriconazol por 10 días, con buena evolución. En los casos presentados, debido a la ausencia de otros aislamientos microbiológicos y a la buena respuesta al tratamiento antifúngico junto con el recambio de la sonda vesical, se asumió al Trichosporon asahii como el probable agente causal de la sepsis.


Trichosporon asahii is a ubiquitous fungus that has been isolated as part of human microbiota. There has been an emergence of this pathogen in recent years, causing superficial and deep seated infections. There are scarce reports of urinary tract infections in pediatric intensive care burn units caused by this agent. We describe the cases of 2 pediatric patients with prolonged hospitalization due to severe burns that had received several antibiotic courses for previous infections. Both presented sepsis secondary to catheter related urinary tract infection by Trichosporon asahii. Both patients underwent urinary catheter replacement and were treated effectively with voriconazole for 10 days. In the cases presented, sepsis was assumed to be due to Trichosporon asahii since no other microorganism was identified and the patients showed favorable outcome with the prescribed treatment with voriconazole and replacement of the urinary catheter.


Subject(s)
Humans , Male , Child, Preschool , Urinary Tract Infections/etiology , Sepsis/etiology , Catheter-Related Infections/etiology , Trichosporonosis/etiology , Urinary Catheters/adverse effects , Burn Units , Burns/complications
14.
Pesqui. vet. bras ; 37(9): 937-940, Sept. 2017. ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-895524

ABSTRACT

A leptospirose é uma doença infecciosa causada por bactérias do gênero Leptospira, que afeta animais domésticos, selvagens e também humanos. De outubro a novembro de 2014, numa propriedade rural localizada em Glorinha, RS, em que bovinos eram mantidos em resteva de arroz, 13 bezerros manifestaram hemoglobinúria e apatia, nove dos quais morreram em menos de 24 horas após o início dos sinais clínicos. Foram necropsiados quatro bezerros (A, B, C e D). Fragmentos de tecido foram fixados em formalina a 10%. Amostras de rim, fígado e pulmão dos Bezerros B, C e D foram enviadas para análise de PCR para RNA ribossômico 16S e a proteína Lip 32 de Leptospira. No exame macroscópico foram observados mucosas e tecido subcutâneo amarelados, fígado alaranjado, pulmões com múltiplas petéquias, predominantemente nos lóbulos craniais. A cavidade torácica do Bezerro A estava repleta de um líquido vermelho-escuro. À avaliação microscópica foi observada hemorragia acentuada nos pulmões; no fígado havia necrose e vacuolização hepatocelular centrolobular difusa moderada, além de infiltrado linfocítico periportal discreto. Nos rins observou-se nefrite intersticial linfoplasmocítica discreta multifocal. A análise por PCR teve resultado positivo para os Bezerros B e D. O diagnóstico de leptospirose nos bezerros foi baseado nos achados epidemiológicos, clínicos e patológicos, associados ao resultado positivo na PCR. Este estudo demonstra a importância da investigação da doença quando animais jovens são criados em áreas inundadas e têm manifestações clínicas de doença septicêmica aguda.(AU)


Leptospirosis is an infectious disease caused by bacteria of the genus Leptospira, which affect domestic and wild animals, and also humans. From October to November 2014, in a rural property located in Glorinha, RS, where cattle were kept in the rice stubble, thirteen calves presented hemoglobinuria and apathy, nine of which died within less than 24 hours after the onset of clinical signs. Four calves were necropsied (A, B, C and D). Tissue samples were collected in 10% formalin. Samples of kidney, liver and lung from calves B, C and D were sent for PCR analysis for 16S ribosomal RNA and the protein Lip 32 genes of Leptospira. At macroscopic examination jaundiced mucosae and subcutaneous tissue, orange liver, and lungs with multiple petechiae, predominantly in cranial lobes, were observed. The thoracic cavity of calf A was filled with a reddish fluid. At microscopic examination, severe hemorrhage was observed in the lungs; in the liver there was moderate diffuse centrilobular hepatocellular necrosis and vacuolization, in addition to discrete periportal lymphocytic infiltrate. Discrete multifocal lymphoplasmocytic interstitial nephritis was observed in the kidneys. PCR analyzis resulted positive for calves B and D. The diagnosis of leptospirosis in the calves was based on epidemiological, clinical and pathological findings associated with positive PCR analysis. This study demonstrates the importance of investigation of the disease when young bovids are raised in flooded areas and have clinical signs of an acute septicemic disease.(AU)


Subject(s)
Animals , Cattle , Sepsis/etiology , Leptospira/isolation & purification , Leptospirosis/veterinary , Leptospirosis/epidemiology , Animal Feed , Oryza , Polymerase Chain Reaction/veterinary
15.
Rev. Assoc. Med. Bras. (1992) ; 63(7): 613-620, July 2017. tab, graf
Article in English | LILACS | ID: biblio-896372

ABSTRACT

Summary Introduction: Central venous catheters are fundamental to daily clinical practice. This procedure is mainly performed by residents, often without supervision or structured training. Objective: To describe the characteristics of central venous catheterization and the complication rate related to it. Method: Retrospective cohort study. Adult patients undergoing central venous catheter insertion out of the intensive care unit (ICU) of a teaching hospital were selected from March 2014 to February 2015. Data were collected from medical charts using an electronic form. Clinical and laboratory characteristics from patients, procedure characteristics, and mechanical and infectious complications rates were assessed. Patients with and without complications were compared. Results: Three hundred and eleven (311) central venous catheterizations were evaluated. The main reasons to perform the procedure were lack of peripheral access, chemotherapy and sepsis. There were 20 mechanical complications (6% of procedures). Arterial puncture was the most common. Procedures performed in the second semester were associated with lower risk of complications (odds ratio 0.35 [95CI 0.12-0.98; p=0.037]). Thirty-five (35) catheter-related infection cases (11.1%) were reported. They were related to younger patients and procedures performed by residents with more than one year of training. Procedures performed after the first trimester had a lower chance of infection. Conclusion: These results show that the rate of mechanical complications of central venous puncture in our hospital is similar to the literature, but more attention should be given to infection prevention measures.


Resumo Introdução: Cateteres venosos centrais são fundamentais na prática clínica diária. Em hospitais de ensino, esse procedimento é realizado por médicos residentes, frequentemente sem supervisão ou treinamento estruturado. Objetivo: Descrever as características das punções venosas centrais e a taxa de complicações relacionadas. Método: Estudo de coorte retrospectiva. Foram selecionados pacientes adultos submetidos a punção venosa central fora de unidade de terapia intensiva (UTI) de um hospital de ensino no ano letivo de 2014 (março de 2014 a fevereiro de 2015). Os dados foram coletados por meio de revisão de prontuários com o uso de formulário eletrônico. Foram avaliadas características clínicas e laboratoriais dos pacientes, características do procedimento, taxa de complicações mecânicas e infecciosas relacionadas. Foram comparados os pacientes com complicações em relação àqueles sem complicações. Resultados: Foram avaliadas 311 punções venosas centrais. Os principais motivos para realização do procedimento foram falta de rede periférica, quimioterapia e sepse. Ocorreram 20 complicações mecânicas (6% dos procedimentos); punção arterial foi a mais comum. Procedimentos realizados no segundo semestre do ano letivo foram associados a menor risco de complicações (razão de chances de 0,35 [IC95 0,12-0,98; p=0,037]). Foram descritos 35 casos de infecção relacionada ao cateter (11,1%). Casos de infecção foram associados a pacientes mais jovens e procedimentos realizados por residentes com mais de um ano de treinamento. Procedimentos realizados após o primeiro trimestre tiveram menor chance de infecção. Conclusão: Esses resultados mostram que a taxa de complicações mecânicas de punção venosa central em nosso hospital é semelhante à da literatura; porém, maior atenção deve ser dada para medidas de prevenção de infecção.


Subject(s)
Humans , Male , Female , Adult , Catheterization, Central Venous/adverse effects , Catheter-Related Infections/prevention & control , Central Venous Catheters/adverse effects , Pneumothorax/etiology , Brazil , Catheterization, Central Venous/statistics & numerical data , Retrospective Studies , Risk Factors , Sepsis/etiology , Hospitals, Teaching , Middle Aged
16.
Rev. méd. Chile ; 145(6): 755-759, June 2017. tab
Article in Spanish | LILACS | ID: biblio-1043143

ABSTRACT

Background: Early inappropriate antibiotic therapy for the management of urosepsis is associated with higher mortality. Therefore, to establish an adequate empirical therapy is crucial. Aim: To determine an optimal antibiotic treatment, adjusted according local bacterial resistance in patients diagnosed with urosepsis secondary to ureteral lithiasis. Material and Methods: Urine cultures and blood cultures from a prospective cohort of patients with ureteral lithiasis admitted for urosepsis in our center between November 2013 and May 2016, were reviewed. Patients who presented two or more criteria of systemic inflammatory response syndrome (SIRS) and positive blood or urine cultures were admitted. Antimicrobial sensitivity patters derived from cultures were analyzed to describe bacterial susceptibility to commonly used antibiotics. Results: Data from 31 patients were analyzed. Seventeen blood cultures (55%) and 29 urine cultures (94%) were positive. The most commonly isolated pathogens were Escherichia coli in 65% of the cultures, followed by Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis. After performing an analysis of sensitivity and resistance for all bacteria in both blood and urine cultures, amikacin showed the highest sensitivity (100%), followed by 2nd and 3rd generation cephalosporins. Conclusions: Amikacin demonstrated higher antibiotic sensitivity in comparison to other antibiotics for empirical management of patients with urosepsis secondary to ureteral lithiasis.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Urinary Tract Infections/urine , Amikacin/pharmacology , Sepsis/urine , Escherichia coli/drug effects , Anti-Bacterial Agents/pharmacology , Urinary Tract Infections/etiology , Urinary Tract Infections/blood , Microbial Sensitivity Tests , Prospective Studies , Sepsis/etiology , Sepsis/blood , Ureterolithiasis/complications , Blood Culture
17.
An. bras. dermatol ; 92(3): 383-385, May-June 2017. graf
Article in English | LILACS | ID: biblio-886969

ABSTRACT

Abstract Crusted or Norwegian scabies is a parasitic infectious disease caused by Sarcoptes scabiei var. hominis that mainly affects immunocompromised individuals and those with neurological patients. We report a case of crusted scabies in a 4-month-old infant who had been treated erroneously for atopic dermatitis with high doses of corticosteroids. This initial misdiagnosis associated with the abusive use of corticosteroid facilitated the evolution of scabies to crusted scabies and its main complications of secondary infection and sepsis.


Subject(s)
Humans , Male , Infant , Adolescent , Scabies/diagnosis , Scabies/drug therapy , Sepsis/etiology , Permethrin/therapeutic use , Glucocorticoids/adverse effects , Scabies/complications , Immunocompromised Host , Fatal Outcome , Diagnostic Errors
19.
Rev. chil. pediatr ; 88(4): 534-540, 2017.
Article in Spanish | LILACS | ID: biblio-900015

ABSTRACT

Los probióticos son microorganismos vivos que cuando son administrados en cantidades adecuadas confieren beneficios a la salud del huésped. Su empleo es muy amplio en todas las edades, y los episodios adversos asociados con ellos, incluyendo casos de sepsis, que hagan suponer un riesgo real y manifiesto de invasión del torrente sanguíneo o algún tipo de contagio son muy infrecuentes. Sin embargo, algunos profesionales de la salud manifiestan dudas respecto de su inocuidad. Esta revisión revela que la incidencia de sepsis por probióticos, principalmente lactobacilos y bifidobacterias, evaluada en casuísticas numerosas a lo largo de decenios usando métodos de biología molecular o cultivos, es muy baja: del orden de 0,021% en algunas estadísticas y podría llegar hasta 1 caso/1.000.000 de habitantes. Estos datos son importantes teniendo en cuenta el empleo masivo de diversas especies y cepas, sin restricciones de ninguna especie y en todas las edades. Algunos estudios que comunican otros efectos adversos tienen problemas de diseño que ponen en duda su validez. Por el contrario, se ha demostrado que los probióticos ejercen efectos positivos estimulando la inmunidad innata y adquirida, en el tratamiento de la atopia y eccema y en la prevención de la enterocolitis necrosante en sujetos tan vulnerables como los prematuros.


Probiotics have been defined as live microorganisms which, when ingested in adequate numbers, confer health benefits to the host. They are currently consumed without any age restrictions and adverse effects such as sepsis, a marker of the risk of invasion of the bloodstream, are extremely infrequent. However, some health professionals express doubts about probiotics being truly innocuous. This review discusses the incidence of sepsis secondary to probiotics use, mainly lactobacilli and bifidobacteria, evaluated through molecular biology or classic culture techniques, showing that sepsis in large numbers of individuals along decennia is extremely low, of the order of 0,02% en some centers or as low as 1 case/million population in France. These data are important considering the use different species and strains of these microorganisms. Few studies which have reported other adverse effects but many of these have problems with their design that cast doubt about the validity of their results. On the contrary, it has been shown that probiotic microorganisms exert positive stimulatory effects on innate and acquired immunity, with decrease of the manifestations of atopy and eczema. These positive effects are further evidenced by the beneficial effects of many species of probiotics in preventing necrotizing enterocolitis in patients as functionally labile as premature-born babies.


Subject(s)
Humans , Sepsis/etiology , Probiotics/adverse effects , Bifidobacterium , Risk , Probiotics/therapeutic use , Enterocolitis, Necrotizing/prevention & control , Dermatitis, Atopic/prevention & control , Lactobacillus
20.
Salud pública Méx ; 58(3): 385-392, may.-jun. 2016. tab, graf
Article in Spanish | LILACS | ID: lil-793020

ABSTRACT

Resumen: Objetivo: Caracterizar las manifestaciones clínicas y predictores de mortalidad en niños hospitalizados por fiebre maculosa de las Montañas Rocosas (FMMR). Material y métodos: Estudio transversal en 210 sujetos hospitalizados por FMMR en un hospital pediátrico de Sonora, entre el 1 de enero de 2004 y el 30 de junio de 2015. El análisis se sustentó en estadística descriptiva y regresión logística multivariada. Resultados: Se apreció un incremento en la incidencia y mortalidad en los casos hospitalizados por FMMR, con una letalidad de 30%.Tres variables se asociaron con el riesgo de muerte: retraso ≥ 5 días en el inicio del uso de doxiciclina (RMa=2.95, IC95% 1.10-7.95), falla renal aguda (RMa=8.79, IC95% 3.46-22.33) y sepsis severa (RMa=3.71, IC95% 1.449.58). Conclusión: La FMMR provoca resultados fatales en niños, que puede evitarse con la administración oportuna de doxiciclina. La falla renal aguda y la sepsis severa son dos predictores de muerte en niños con FMMR.


Abstract: Objective: Characterize clinical manifestations and predictors of mortality in children hospitalized for spotted fever. Materials and methods: Cross-sectional study in 210 subjects with a diagnosis of Rocky Mountain spotted fever (RMSF) in a pediatric hospital in Sonora, from January 1st, 2004 to June 30th, 2015. Data were analyzed using descriptive statistics and multivariate logistic regression. Results: An upward trend was observed in RMSF morbidity and mortality. Fatality rate was 30%.Three predictors were associated with risk of death: delay ≥ 5 days at the start of doxycycline (ORa= 2.95, 95% CI 1.10-7.95), acute renal failure ((ORa= 8.79, 95% CI 3.46-22.33) and severe sepsis (ORa= 3.71, 95% CI 1.44-9.58). Conclusions: RMSF causes high mortality in children, which can be avoided with timely initiation of doxycycline. Acute renal failure and severe sepsis are two independent predictors of death in children with RMSF.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Rocky Mountain Spotted Fever/epidemiology , Rocky Mountain Spotted Fever/complications , Rocky Mountain Spotted Fever/mortality , Cross-Sectional Studies , Risk Factors , Morbidity/trends , Mortality/trends , Sepsis/etiology , Sepsis/mortality , Acute Kidney Injury/etiology , Acute Kidney Injury/mortality , Mexico/epidemiology
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