Nanostructured Glass-Ceramic Materials from Glass Waste with Antimicrobial Activity.

Modern consumption patterns have led to a surge in waste glass accumulating in municipal landfills, contributing to environmental pollution, especially in countries that do not have well-established recycling standards. While glass itself is 100% recyclable, the logistics and handling involved present significant challenges. Flint and amber-colored glass, often found in high quantities in municipal waste, can serve as valuable sources of raw materials. We propose an affordable route that requires just a thermal treatment of glass waste to obtain glass-based antimicrobial materials. The thermal treatment induces crystallized nanoregions, which are the primary factor responsible for the bactericidal effect of waste glass. As a result, coarse particles of flint waste glass that undergo thermal treatment at 720 °C show superior antimicrobial activity than amber waste glass. Glass-ceramic materials from flint waste glass, obtained by thermal treatment at 720 °C during 2 h, show antimicrobial activity against Escherichia coli after just 30 min of contact time. Laser-induced breakdown spectroscopy (LIBS) was employed to monitor the elemental composition of the glass waste. The obtained glass-ceramic material was structurally characterized by transmission electron microscopy, enabling the confirmation of the presence of nanocrystals embedded within the glass matrix.

The Impact of Polyphosphates on the Colloidal Stability of Laponite Particles.

The effect of polyphosphate (polyP) adsorption on the colloidal properties of disc-shaped laponite (LRD) particles was examined in aqueous dispersions with a focus on elucidating the interparticle forces that govern the colloidal stability of the systems. The charge and aggregation rate data of bare LRD exhibited an ionic strength-dependent trend, confirming the presence of double-layer repulsion and van der Waals attraction as major surface interactions. The charge of LRD particles significantly increased in magnitude at elevated polyP concentrations as a result of polyP adsorption and subsequent overcharging of the positively charged sites on the edges of the LRD discs. A transition from stable to unstable LRD colloids was observed with increasing polyP doses indicating the formation of aggregates in the latter systems due to depletion forces and/or bridging interactions induced by dissolved or adsorbed polyP, respectively. The degree of phosphate polymerization influenced neither the charge nor the aggregation mechanism. The findings clearly confirm that polyP adsorption was the driving phenomenon to induce particle aggregation in contrast to other clay types, where phosphate derivatives act as dispersion stabilizing agents. This study provides valuable insights into the early stages of aggregation in colloidal systems involving LRD and polyPs, which have a crucial role in predicting further material properties that are important to designing LRD-polyP composites for applications such as potential phosphate sources in chemical fertilizers.

Trimethoprim-Based multicomponent solid Systems: Mechanochemical Screening, characterization and antibacterial activity assessment.

In this work, multicomponent trimethoprim-based pharmaceutical solid systems were developed by mechanochemistry, using coformers from the GRAS list and other active pharmaceutical ingredients. The choice of coformers took into account their potential to increase the aqueous solubility/dissolution rate of TMP or its antibacterial activity. All the binary systems were characterized by thermal analysis, powder X-ray diffraction and infrared spectroscopy, and 3 equimolar systems with FTIR pointing to salts, and 4 eutectic mixtures were identified. The intrinsic dissolution rate of TMP in combination with nicotinic acid (a salt) and with paracetamol (eutectic mixture) were 25% and 5% higher than for pure TMP, respectively. For both Gram-positive and -negative strains, the antibacterial activity of TMP with some of the coformers was improved, since the dosage used was lower than the TMP control. A significant increase in antibacterial activity against E. coli was found for the eutectic mixture with curcumin, with the best results being obtained for the eutectic and equimolar mixtures with ciprofloxacin. Combining trimethoprim with coformers offers an interesting alternative to using trimethoprim alone: multicomponent forms with enhanced TMP dissolution rates were identified, as well as combinations showing enhanced antibacterial activity relatively to the pure drug.

In-shoe plantar pressure measurement technologies for the diabetic foot: A systematic review.

Introduction: Loss of cutaneous protective sensation and high plantar pressures increase the risk for diabetic foot patients. Trauma and ulceration are imminent threats, making assessment and monitoring essential. This systematic review aims to identify systems and technologies for measuring in-shoe plantar pressures, focusing on the at-risk diabetic foot population. Methods: A systematic search was conducted across four electronic databases (Scopus, Web of Science, PubMed, Oxford Journals) using PRISMA methodology, covering articles published in English from 1979 to 2024. Only studies addressing systems or sensors exclusively measuring plantar pressures inside the shoe were included. Results: A total of 87 studies using commercially available devices and 45 articles proposing new systems or sensors were reviewed. The prevailing market offerings consist mainly of instrumented insoles. Emerging technologies under development often feature configurations with four, six or eight resistive sensors strategically placed within removable insoles. Despite some variability due to the inherent heterogeneity of human gait, these devices assess plantar pressure, although they present significant differences between them in measurement results. Individuals with diabetic foot conditions appears exhibit elevated plantar pressures, with reported peak pressures reaching approximately 1000 kPa. The results also showed significant differences between the diabetic and non-diabetic groups. Conclusion: Instrumented insoles, particularly those incorporating resistive sensor technology, dominate the field. Systems employing eight sensors at critical locations represent a pragmatic approach, although market options extend to systems with up to 960 sensors. Differences between devices can be a critical factor in measurement and highlights the importance of individualized patient assessment using consistent measurement devices.

Cutaneous Mucormycosis in a Young Immunocompetent Trauma Patient: A Case Report.

Introduction: Mucormycosis, a rare and life-threatening infection, is caused by microorganisms of the Mucorales order. It affects almost exclusively immunocompromised and diabetic patients, requiring extensive surgical debridement and prolonged antifungal therapy. Discussion/Results: We report the case of a 26-year-old immunocompetent woman, presenting with cutaneous mucormycosis after suffering blunt force trauma. This rare occurrence of mucormycosis in an immunocompetent patient reinforces the importance of elevated clinical suspicion and early initiation of adequate surgical and antifungal treatment. Conclusion: Mucormycosis is a challenging condition with potentially devastating consequences. Timely diagnosis and appropriate management are vital to mitigate the morbidity and mortality associated with this condition. LEARNING POINTS: Cutaneous mucormycosis is a rare life-threatening infection that affects mainly immunocompromised patients.Certain circumstances warrant a high index of clinical suspicion in immunocompetent patients, and indicate histopathological examination.Treatment involves a multidisciplinary approach with aggressive surgical debridement, antifungal therapy, and elimination of risk factors.

A protocol for an international, multicentre pharmacokinetic study for Screening Antifungal Exposure in Intensive Care Units: The SAFE-ICU study.

Objective: To describe whether contemporary dosing of antifungal drugs achieves therapeutic exposures in critically ill patients that are associated with optimal outcomes. Adequate antifungal therapy is a key determinant of survival of critically ill patients with fungal infections. Critical illness can alter an antifungal agents' pharmacokinetics, increasing the risk of inappropriate antifungal exposure that may lead to treatment failure and/or toxicity. Design setting and participants: This international, multicentre, observational pharmacokinetic study will comprise adult critically ill patients prescribed antifungal agents including fluconazole, voriconazole, posaconazole, isavuconazole, caspofungin, micafungin, anidulafungin, and amphotericin B for the treatment or prophylaxis of invasive fungal disease. A minimum of 12 patients are targeted for enrolment for each antifungal agent, across 12 countries and 30 intensive care units to perform descriptive pharmacokinetics. Pharmacokinetic sampling will occur during two dosing intervals (occasions): firstly, between days 1 and 3, and secondly, between days 4 and 7 of the antifungal course, collecting three samples per occasion. Patients' demographic and clinical data will be collected. Main outcome measures: The primary endpoint of the study is attainment of pharmacokinetic/pharmacodynamic target exposures that are associated with optimal efficacy. Thirty-day mortality will also be measured. Results and conclusions: This study will describe whether contemporary antifungal drug dosing achieves drug exposures associated with optimal outcomes. Data will also be used for the development of antifungal dosing algorithms for critically ill patients. Optimised drug dosing should be considered a priority for improving clinical outcomes for critically ill patients with fungal infections.

Exploring the Applicability of Physiological Monitoring to Manage Physical Fatigue in Firefighters.

Physical fatigue reduces productivity and quality of work while increasing the risk of injuries and accidents among safety-sensitive professionals. To prevent its adverse effects, researchers are developing automated assessment methods that, despite being highly accurate, require a comprehensive understanding of underlying mechanisms and variables' contributions to determine their real-life applicability. This work aims to evaluate the performance variations of a previously developed four-level physical fatigue model when alternating its inputs to have a comprehensive view of the impact of each physiological variable on the model's functioning. Data from heart rate, breathing rate, core temperature and personal characteristics from 24 firefighters during an incremental running protocol were used to develop the physical fatigue model based on an XGBoosted tree classifier. The model was trained 11 times with different input combinations resulting from alternating four groups of features. Performance measures from each case showed that heart rate is the most relevant signal for estimating physical fatigue. Breathing rate and core temperature enhanced the model when combined with heart rate but showed poor performance individually. Overall, this study highlights the advantage of using more than one physiological measure for improving physical fatigue modelling. The findings can contribute to variables and sensor selection in occupational applications and as the foundation for further field research.

Who gets burned in Brazil?

Burns are preventable injuries that still represent a relevant public health issue. The identification of risk factors might contribute to the development of specific preventive strategies. Data of patients admitted at the Hospital due to acute burn injuries from May 2017 to December 2019, was extracted manually from medical records. The population was analyzed descriptively, and differences between groups were tested using the appropriate statistical test. The study population consisted of 370 patients with burns admitted to the Hospital burn unit during the study period. The majority of the patients were males (257/370, 70%), median age was 33 (IQR:18-43), median TBSA% was 13 (IQR 6.35-21.5 and range 0-87.5%), and 54% of patients had full thickness burns (n=179). Children younger than 13 years old represented 17% of the study population (n=63), 60% of them were boys (n= 38), and scalds was the predominant mechanism of burn injury (n= 45). No children died, however 10% of adults did (n= 31). Self-inflicted burns were observed in 16 adults (5%), of whom 6 (38%) died during admission, however self-inflicted burns were not observed in children. Psychiatric disorders and substance misuse were frequent in this subgroup. White adults male from urban areas who had not completed primary school degree were the major risk group for burns. Smoking and alcohol misuse were the most frequent comorbidities. Accidental domestic flame burns were the predominant injuries in the adult population and scalds in the pediatric.

Norfloxacin Cocrystals: Mechanochemical Synthesis and Scale-up Viability Through Solubility Studies.

Cocrystals are recognized as one of the most efficient approaches to improve aqueous solubility of Biopharmaceutical Classification System, BCS, classes II and IV drugs. Cocrystal discovery and the establishment of experimental conditions suitable for scale-up purposes are some of the main challenges in cocrystal investigation. In this work, the investigation of mechanochemical synthesis of norfloxacin cocrystals with picolinic and isonicotinic acids is performed, leading to the discovery of two new cocrystals of this important BCS class IV antibiotic, which were characterized through thermal, spectral and diffractometric analysis. Norfloxacin apparent aqueous solubility using the cocrystals is also presented, with higher values being obtained for all the investigated systems when compared to the pure drug. Norfloxacin has 3 polymorphs and several solvents/hydrates, which represents a challenge for obtaining pure cocrystal forms from solvent crystallization. This challenge was successfully overcome in this work, as experimental conditions to obtain the pure cocrystals (the new ones and also norfloxacin-nicotinic acid and norfloxacin-saccharin) were established using Crystal16 equipment. This is a crucial step to envisage future scale-up procedures and therefore a valuable information for the pharmaceutical industry.

Prevalence and factors associated with Frailty Syndrome in elderly people in Joinville / Prevalencia y factores asociados al Síndrome de Fragilidad en adultos mayores de Joinville / Prevalência e fatores associados à Síndrome da Fragilidade em idosos de Joinville

INTRODUCTION: With the aging of the Brazilian population, to scale and evaluate the profile of the vulnerable population for having the Frailty Syndrome in Elderly (FSE) and understanding its associated factors is of great importance. OBJECTIVE: To analyze the profile of elders corresponding to the information referred in the frailty indicators on the Edmonton Frail Scale on a geriatric specialized facility. METHODOLOGY: The present study is a cross-sectional, analytical study, with the elders from a geriatrics specialized facility in Joinville, Brazil. It was analyzed the social-economic profiles (gender, ethnicity, income and schooling) and the evaluation for the FSE, as well as comorbidities present. The project has been approved by the Ethics in Research Committee of UNIVILLE under the protocol number 40940020.6.0000.5366. RESULTS: the results were obtained from the 141 elderly interviewed, with 74 years old as the average age. Majority (60%) female, white (90,2%), of low scholar education (56%) and married or in a stable relationship (53,2%). The prevalence of some sort of fragility was of 17,7% (IC95%). DISCUSSION: Although the discussion over the criteria to establish FSE, the present study was based on the Edmonton Frail Scale. The local sample analyzed demonstrated how the discussion over schooling, smoking, income and the high rates of comorbidities predisposes to FSE and, in that way, also in a higher prevalence of elderly falls. This aligns with previous literature studies which showcase higher prevalence of falls in patients with these epidemiological characteristics. CONCLUSION: Despite some limitations of this present study, such as it being done in a well respected specialized geriatric facility, it does demonstrate the local profile of the elderly stricken with FSE.

INTRODUCCIÓN: Con el envejecimiento de la población brasileña, escalar y evaluar el perfil de la población vulnerable por tener el Síndrome de Fragilidad del Anciano (FSE) y comprender sus factores asociados es de gran importancia. OBJETIVO: Analizar el perfil de los ancianos correspondientes a las informaciones referidas en los indicadores de fragilidad de la Escala de Fragilidad de Edmonton en un establecimiento especializado en geriatría. METODOLOGÍA: El presente estudio es un estudio transversal, analítico, con ancianos de una unidad especializada en geriatría de Joinville, Brasil. Se analizaron los perfiles socioeconómicos (género, etnia, renta y escolaridad) y la evaluación para el FSE, así como las comorbilidades presentes. El proyecto ha sido aprobado por el Comité de Ética en Investigación de UNIVILLE bajo el protocolo número 40940020.6.0000.5366. RESULTADOS: los resultados fueron obtenidos de los 141 ancianos entrevistados, con 74 años como promedio de edad. Mayoritariamente (60%) mujeres, blancas (90,2%), de baja escolaridad (56%) y casadas o en pareja estable (53,2%). La prevalencia de algún tipo de fragilidad fue del 17,7% (IC95%). DISCUSIÓN: A pesar de la discusión sobre los criterios para establecer FSE, el presente estudio se basó en la Escala de Frágil de Edmonton. La muestra local analizada demostró cómo la discusión sobre la escolaridad, el tabaquismo, la renta y los altos índices de comorbilidades predisponen a la EEF y, de ese modo, también a una mayor prevalencia de caídas en ancianos. Esto se alinea con estudios previos de la literatura que muestran una mayor prevalencia de caídas en pacientes con estas características epidemiológicas. CONCLUSIÓN: A pesar de algunas limitaciones de este presente estudio, como que se realizó en un centro geriátrico especializado muy respetado, demuestra el perfil local de los ancianos afectados por FSE.

INTRODUÇÃO: Com o envelhecimento da população Brasileira, dimensionar e avaliar o perfil da população vulnerável a ter a Síndrome da Fragilidade no Idoso (SFI) e entender seus fatores associados é de grande importância. OBJETIVO: Analisar o perfil de idosos que correspondem às informações referentes aos indicadores de fragilidade do questionário de fragilidade de Edmonton, em uma clínica especializada em geriatria. MÉTODO: O presente estudo é do tipo transversal, analítico, com idosos da Unidade especializada de atenção geriátrica em Joinville, Brasil. Foram analisados perfil social econômico (escolaridade, renda, raça, sexo) e a avaliação para a SFI e as comorbidades no idoso. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da UNIVILLE sob parecer de n° 40940020.6.0000.5366. RESULTADO: Os resultados do estudo foram a partir dos 141 idosos entrevistados, com uma média de 74 anos de idade. A maioria (60%) do sexo feminino, de cor branca (90,1%), de baixa escolaridade (56%) e casados ou em união estável (53,2%). A prevalência de algum nível de fragilidade foi de 17,7% (IC95%). DISCUSSÃO: Apesar da discussão sobre os critérios para definição da SFI, o presente estudo baseou-se no questionário de fragilidade de Edmonton - Edmonton Frail Scale. A amostra local da população representa como discussão sobre a escolaridade, tabagismo, renda e o grande número de comorbidades predispõe a SFI e, dessa forma, também uma prevalência maior de queda do idoso. Isso converge com estudos prévios na literatura que ilustram maior prevalência de queda em pacientes com esse perfil epidemiológico. Conclusão: Apesar de algumas limitações do estudo como de ter sido realizado em um serviço de referência em geriatria, o estudo molda o perfil local da população idosa acometida pela SFI.

Impact of a 10-min typing task in the development of trapezius myalgia: a preliminary observational study.

Objectives. Computer use, as in typing, might contribute to trapezius myalgia (TM) development by increasing upper trapezius (UT) muscle fatigue. The purpose of this study is to investigate whether 10 min of performing a typing task by a population at risk would show significant changes in surface electromyography (sEMG) and pressure pain threshold (PPT) measurements. Supported and unsupported forearms postures are compared. Methods. Sixteen asymptomatic volunteers with minimum daily use of a computer of 5 h were randomized into two groups: fully supported forearms (n = 8) and unsupported forearms (n = 8). The protocol consisted of 10 min of a typing task, and the workstation was set according to the usual participant profile. sEMG and PPT readings were collected from both UT muscles. Results. PPT and sEMG readings were not significantly different among the two groups. Supported forearms had less reduction of PPT and a smaller increase in electrical activity. Conclusions. Ten minutes of typing seems insufficient to observe any significant changes that could lead to TM development.

Phlegmasia cerulea dolens: a swelling, cyanosis and discolouration of the extremity in the ICU.

Phlegmasia cerulea dolens is a rare entity that causes critical limb ischaemia, which may lead to amputation of the limb and may be life-threatening. Here, we describe a case of a healthy man in his 50s with multiple trauma who was transferred to the intensive care unit (ICU) of a central hospital for neuromonitoring following splenectomy for the stabilisation of a hypovolaemic shock. On admission to the ICU, the patient developed a swollen and white leg. The condition was caused by early compromised arterial flow secondary to extensive deep vein thrombosis.

Frontiers in Occupational Health and Safety Management.

This Special Issue of the International Journal of Environmental Research and Public Health is devoted to the "Frontiers in Occupational Health and Safety Management" [...].

Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review.

Patellofemoral pain syndrome (PFPS) is highly prevalent; it can cause severe pain and evolve into progressive functional loss, leading to difficulties performing daily tasks such as climbing and descending stairs and squatting. This systematic review aimed to find evidence, in the literature, of squat movements that can cause or worsen PFPS. This work was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and its protocol was registered in PROSPERO (CRD42019128711). From the 6570 collected records, 37 were included. From these 37 articles, 27 present a causal relationship between knee flexion and PFPS, 8 describe a relationship, considering the greater existence of muscle contractions, and one article did not describe this relationship in its results. The main limitations stem from the fact that different studies used different evaluation parameters to compare the force exerted on the patellofemoral joint. Furthermore, most studies are focused on sports populations. After analysing the included works, it was concluded that all squat exercises can cause tension overload in the knee, especially with a knee flexion between 60° and 90° degrees. The main causal/worsening factors of PFPS symptoms are the knee translocation forward the toes (on the same body side) when flexing the knee, and the muscle imbalance between the thigh muscles.

Prognostic value of hyperlactatemia in infected patients admitted to intensive care units: a multicenter study. / Valor prognóstico da hiperlactatemia em pacientes admitidos com infecção em unidades de terapia intensiva: estudo multicêntrico.

OBJECTIVE: To evaluate the influence of patient characteristics on hyperlactatemia in an infected population admitted to intensive care units and the influence of hyperlactatemia severity on hospital mortality. METHODS: A post hoc analysis of hyperlactatemia in the INFAUCI study, a national prospective, observational, multicenter study, was conducted in 14 Portuguese intensive care units. Infected patients admitted to intensive care units with a lactate measurement in the first 12 hours of admission were selected. Sepsis was identified according to the Sepsis-2 definition accepted at the time of data collection. The severity of hyperlactatemia was classified as mild (2 - 3.9mmol/L), moderate (4.0 - 9.9mmol/L) or severe (> 10mmol/L). RESULTS: In a total of 1,640 patients infected on admission, hyperlactatemia occurred in 934 patients (57%), classified as mild, moderate and severe in 57.0%, 34.4% and 8.7% of patients, respectively. The presence of hyperlactatemia and a higher degree of hyperlactatemia were both associated with a higher Simplified Acute Physiology Score II, a higher Charlson Comorbidity Index and the presence of septic shock. The lactate Receiver Operating Characteristic curve for hospital mortality had an area under the curve of 0.64 (95%CI 0.61 - 0.72), which increased to 0.71 (95%CI 0.68 - 0.74) when combined with Sequential Organ Failure Assessment score. In-hospital mortality with other covariates adjusted by Simplified Acute Physiology Score II was associated with moderate and severe hyperlactatemia, with odds ratio of 1.95 (95%CI 1.4 - 2.7; p < 0.001) and 4.54 (95%CI 2.4 - 8.5; p < 0.001), respectively. CONCLUSION: Blood lactate levels correlate independently with in-hospital mortality for moderate and severe degrees of hyperlactatemia.

OBJETIVO: Avaliar a influência das características dos pacientes na hiperlactatemia em uma população admitida com infecção em unidades de terapia intensiva, bem como a influência da gravidade da hiperlactatemia na mortalidade hospitalar. METÓDOS: Foi realizada uma análise post hoc da hiperlactatemia no INFAUCI, um estudo nacional prospectivo, observacional e multicêntrico, que incluiu 14 unidades de terapia intensiva portuguesas. Foram selecionados pacientes admitidos com infecção em unidades de terapia intensiva com dosagem de lactato nas primeiras 12 horas de admissão. A sepse foi identificada de acordo com a definição Sepsis-2 aceita no momento da coleta de dados. A gravidade da hiperlactatemia foi classificada como leve (2 - 3,9mmol/L), moderada (4,0 - 9,9mmol/L) ou grave (> 10mmol/L). RESULTADOS: De 1.640 pacientes admitidos com infecção, a hiperlactatemia ocorreu em 934 (57%) e foi classificada como leve, moderada e grave em 57,0%, 34,4% e 8,7% dos pacientes, respectivamente. A presença de hiperlactatemia e um maior grau de hiperlactatemia se associaram a um maior Simplified Acute Physiology Score II, a maior Índice de Comorbidade de Charlson e à presença de choque séptico. Em relação à curva Receiver Operating Characteristic do lactato para mortalidade hospitalar, foi encontrada área sob a curva de 0,64 (IC95% 0,61 - 0,72), que aumentou para 0,71 (IC95% 0,68 - 0,74) quando se combinou o Sequential Organ Failure Assessment. A mortalidade intra-hospitalar com outras covariáveis ajustadas pelo Simplified Acute Physiology Score II se associou à hiperlactatemia moderada e grave, com razão de chances de 1,95 (IC95% 1,4 - 2,7; p < 0,001) e 4,54 (IC95% 2,4 - 8,5; p < 0,001), respectivamente. CONCLUSÃO: Os níveis de lactato sanguíneo correlacionam-se independentemente com a mortalidade intra-hospitalar para graus moderados e graves de hiperlactatemia.

Recommended Antibiotic Dosage Regimens in Critically Ill Patients with Augmented Renal Clearance: A Systematic Review.

PURPOSE: Augmented renal clearance (ARC) is common in critically ill patients and may lead to subtherapeutic levels of antibiotics, thus influencing clinical outcomes and emergence of multidrug-resistant bacteria. The aim of this systematic review was to search the literature for recommendations concerning dosage adjustment for antibiotics administered to critically ill patients with ARC. METHODS: A search of three electronic databases (Pubmed, Embase and Cochrane) was conducted from inception until the end of March 2021, using terms related to: 1) pharmacokinetics/pharmacodynamics (PK/PD), 2) antibiotic, 3) ARC and 4) critically ill. Two reviewers searched for relevant data and included studies suggesting specific doses for critically ill patients with ARC. RESULTS: Forty-seven studies met the inclusion criteria. Dosage recommendations were found for 18 antibiotics. Differences were found in population characteristics, ARC definition, creatinine clearance (CLCR) determination method, PK methodology and definition of PK/PD targets. Cut-off values for CLCR ranged 120-240 mL/min; the most frequently employed method to define CLCR was Cockcroft-Gault estimation; and 83% of studies used population PK models to predict dosing regimens. All antibiotics, except three, needed upward dosing and/or infusion modality adjustments to reach PK/PD targets. CONCLUSION: Despite the lack of high-quality studies and high heterogeneity, incremental dosing adjustment of antibiotics was frequently needed for critically ill patients with ARC to achieve the desired PK/PD targets. More research is needed to enlarge the number of antibiotics with recommendations for ARC and to validate current suggestions based on mathematical models in a clinical scenario.

Valor prognóstico da hiperlactatemia em pacientes admitidos com infecção em unidades de terapia intensiva: estudo multicêntrico / Prognostic value of hyperlactatemia in infected patients admitted to intensive care units: a multicenter study

RESUMO Objetivo: Avaliar a influência das características dos pacientes na hiperlactatemia em uma população admitida com infecção em unidades de terapia intensiva, bem como a influência da gravidade da hiperlactatemia na mortalidade hospitalar. Metódos: Foi realizada uma análise post hoc da hiperlactatemia no INFAUCI, um estudo nacional prospectivo, observacional e multicêntrico, que incluiu 14 unidades de terapia intensiva portuguesas. Foram selecionados pacientes admitidos com infecção em unidades de terapia intensiva com dosagem de lactato nas primeiras 12 horas de admissão. A sepse foi identificada de acordo com a definição Sepsis-2 aceita no momento da coleta de dados. A gravidade da hiperlactatemia foi classificada como leve (2 - 3,9mmol/L), moderada (4,0 - 9,9mmol/L) ou grave (> 10mmol/L). Resultados: De 1.640 pacientes admitidos com infecção, a hiperlactatemia ocorreu em 934 (57%) e foi classificada como leve, moderada e grave em 57,0%, 34,4% e 8,7% dos pacientes, respectivamente. A presença de hiperlactatemia e um maior grau de hiperlactatemia se associaram a um maior Simplified Acute Physiology Score II, a maior Índice de Comorbidade de Charlson e à presença de choque séptico. Em relação à curva Receiver Operating Characteristic do lactato para mortalidade hospitalar, foi encontrada área sob a curva de 0,64 (IC95% 0,61 - 0,72), que aumentou para 0,71 (IC95% 0,68 - 0,74) quando se combinou o Sequential Organ Failure Assessment. A mortalidade intra-hospitalar com outras covariáveis ajustadas pelo Simplified Acute Physiology Score II se associou à hiperlactatemia moderada e grave, com razão de chances de 1,95 (IC95% 1,4 - 2,7; p < 0,001) e 4,54 (IC95% 2,4 - 8,5; p < 0,001), respectivamente. Conclusão: Os níveis de lactato sanguíneo correlacionam-se independentemente com a mortalidade intra-hospitalar para graus moderados e graves de hiperlactatemia.

ABSTRACT Objective: To evaluate the influence of patient characteristics on hyperlactatemia in an infected population admitted to intensive care units and the influence of hyperlactatemia severity on hospital mortality. Methods: A post hoc analysis of hyperlactatemia in the INFAUCI study, a national prospective, observational, multicenter study, was conducted in 14 Portuguese intensive care units. Infected patients admitted to intensive care units with a lactate measurement in the first 12 hours of admission were selected. Sepsis was identified according to the Sepsis-2 definition accepted at the time of data collection. The severity of hyperlactatemia was classified as mild (2 - 3.9mmol/L), moderate (4.0 - 9.9mmol/L) or severe (> 10mmol/L). Results: In a total of 1,640 patients infected on admission, hyperlactatemia occurred in 934 patients (57%), classified as mild, moderate and severe in 57.0%, 34.4% and 8.7% of patients, respectively. The presence of hyperlactatemia and a higher degree of hyperlactatemia were both associated with a higher Simplified Acute Physiology Score II, a higher Charlson Comorbidity Index and the presence of septic shock. The lactate Receiver Operating Characteristic curve for hospital mortality had an area under the curve of 0.64 (95%CI 0.61 - 0.72), which increased to 0.71 (95%CI 0.68 - 0.74) when combined with Sequential Organ Failure Assessment score. In-hospital mortality with other covariates adjusted by Simplified Acute Physiology Score II was associated with moderate and severe hyperlactatemia, with odds ratio of 1.95 (95%CI 1.4 - 2.7; p < 0.001) and 4.54 (95%CI 2.4 - 8.5; p < 0.001), respectively. Conclusion: Blood lactate levels correlate independently with in-hospital mortality for moderate and severe degrees of hyperlactatemia.