Evaluation of the predictive indices for candidemia in an adult intensive care unit

INTRODUCTION: To evaluate predictive indices for candidemia in an adult intensive care unit (ICU) and to propose a new index. METHODS: A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed. RESULTS: There were 18 (15.8%) proven cases of candidemia and 96 (84.2%) cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively. CONCLUSIONS: The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score. .

Corticosteroids and discriminate functions in alcoholic liver disease

Alcohol remain the single most significant cause of liver disease throughout the Western ward, responsible for between 40 and 80 percent of cases of cirrhosis in different countries. A discrimination function [DF], defined as 4.6 x [PT-control in second]+bilirubin [mg/dL]; when the result is greater than 32, a mortality rate of 50 percent can be predicted within one month. Many of the factors underlying the development of alcoholic liver injury remain unknown, and significant questions remain about the value of even very basic therapeutic strategies. A total number of 31 patients [pts] with ALD attending the Gastroenterology and Herpetology teaching hospital were studied. With DF > 32 divided into 2 groups one [10 pts] given prednisolone tab. 40 m for 1 month and tapered over 1 month, the second group [21 pts] received only conventional treatment and both followed for a year. There was significant improvement in survival in ALD patient treated with prednisolone. The survival rate at one year was 90 percent in prednisolone group and 29 percent in those who received conventional treatment. Glucocorticoid was effective in reducing mortality at one year in patients with DF>32

Doença hepática alcoólica em Caxias do Sul / Alcoholic liver disease in Caxias do Sul

Motivados por um dos maiores coeficientes de mortalidade por cirrose alcoólica do Brasil, observado na cidade de Caxias do Sul, os autores estudaram 81 etilistas crônicos deste local, avaliando os padröes de ingestäo alcoólica (quantidade, duraçäo e uso contínuo), o quadro clínico, testes hepáticos, a laparoscopia e a biópsia hepática com estudo histológico. relatam incidência maior do sexo masculino em relaçäo ao feminino (5:1), predominância de casos entre a quarta e a sexta décadas de vida, com média de 46,2 anos, longa história de ingestäo alcoólica (91,5 por cento dos pacientes bebiam há mais de dez anos) e com quantidades grandes (98,5 por cento ingeriam mais do que os valores considerados de risco para o desenvolvimento de hepatopatia crônica grave). O quadro clínico foi variável desde sintomas vagos até quadros graves e o dado mais encontrado foi a hepatomegalia (64 por cento). No exame histológico, o achado mais encontrado foi a esteatose (presente em 68 por cento dos casos e sendo o diagnóstico principal em 30 por cento), seguida da cirrose em 27 por cento dos pacientes; a hepatite alcoólica foi encontrada em 13,5 por cento e a fibrose centrolobular em 21 por cento