Current perspectives on defining and mitigating frailty in relation to critical illness.

Up to half of ICU survivors, many of whom were premorbidly well, will have residual functional and/or cognitive impairment and be vulnerable to future health problems. Frailty describes vulnerability to poor resolution of homeostasis after a stressor event but it is not clear whether the vulnerability seen after ICU correlates with clinical measures of frailty. In clinical practice, the scales most commonly used in critically ill patients are based on the assessment of severity and survival. Identification and monitoring of frailty in the ICU may be an alternative or complimentary approach, particularly if it helps explain vulnerability during the recovery and rehabilitation period. The purpose of this review is to discuss the use of tools to assess frailty status in the critically ill, and consider their importance in clinical practice. Amongst these, we consider biomarkers with potential to identify patients at greater or lesser risk of developing post-ICU vulnerability.

Placa eritemato descamativa / Erythematous Scaly Plaque

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Prediction of Death with the FRAIL-NH in Institutionalized Older Adults: A Longitudinal Study from a Middle-Income Country.

BACKGROUND/OBJECTIVES: Frailty is common in nursing homes. However, few studies reported longitudinal validation for death prediction or cut-off scores with the FRAIL-NH, which is designed to be used in nursing homes. Moreover, no studies came from Latin America, where frailty is highly prevalent. Our objectives were to evaluate (1) the prevalence of frailty according to the FRAIL-NH scale, and (2) its association to and the best cut-off score for predicting death after 12 months. DESIGN: longitudinal study with 12-month follow-up. SETTING: 6 nursing homes in southwest of Brazil. PARTICIPANTS: 293 residents with 60 years old or more. METHODS: Frailty was evaluated through the FRAIL-NH scale. Logistic regression was used to estimate the associated between frailty and mortality adjusted for age and sex. ROC curve was used to evaluate the accuracy of the scale for mortality prediction. RESULTS: Frailty was prevalent (47.4%) and was associated with death (odds ratio=1.31, 95% confidence interval [CI]=1.18-1.48, p<0.001). The area under the curve was 0.741 (95%CI=0.68-0.79). The sensitivity and specificity of the FRAIL-NH scale according to the best value of the Youden Index was 72.9% and 66.5%, respectively, for a cut-off > 8 points. CONCLUSIONS: Frailty is prevalent in nursing homes according to the FRAIL-NH and it was associated with one-year prediction of death for a cut-off > 8 points.

Recomendaciones en la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria / Recommendations on Testing Before Outpatient Dermatologic Surgery

Introducción: La cirugía dermatológica ambulatoria es una práctica clínica cada vez más habitual, basada en la extirpación de tumores cutáneos mediante anestesia local y con un tiempo quirúrgico reducido. Tradicionalmente, la valoración preoperatoria se ha realizado con el fin de detectar alguna alteración o proceso patológico desconocido que pudiera modificar el plan anestésico y/o quirúrgico. Existe una gran variabilidad entre centros y especialistas sobre las pruebas a solicitar en aquellos pacientes que van a ser sometidos a una intervención quirúrgica dermatológica ambulatoria, teniendo en cuenta que, por el perfil de esta cirugía, prácticamente ningún hallazgo podría modificar o contraindicar la intervención. El objetivo es ofrecer una referencia de actuación para la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria. Métodos: En 2017 se desarrolló en nuestro centro un protocolo para intentar unificar la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria. Se realizó un estudio observacional, descriptivo y retrospectivo analizando las pruebas solicitadas a pacientes sometidos a este tipo de cirugía, comparando antes y después de la aplicación del protocolo. Resultados: Tras la instauración del protocolo se solicitó menor número de pruebas complementarias, sin diferencias estadísticamente significativas en el tipo de cirugía ni complicaciones postoperatorias. Conclusiones: Los pacientes que vayan a ser sometidos, bajo anestesia local, a cirugía dermatológica ambulatoria, y que se encuentren en su estado de salud habitual, podrían no tener indicación de realización de pruebas complementarias preoperatorias

Introduction: Short-duration ambulatory surgery for the removal of skin tumors under local anesthesia is increasingly common in dermatology. Preoperative assessment has traditionally targeted the identification of any unknown diseases or other health conditions that might lead to changes in plans for anesthesia or surgery. Hospitals and specialists differ greatly in the tests they order in patients about to undergo outpatient dermatologic surgery given that hardly any finding would be likely to contraindicate or lead to changes in the procedure. This study aimed to provide guidance for those ordering tests before outpatient dermatologic surgery. Methods: In 2017 our hospital developed a protocol to standardize preoperative testing for outpatient dermatologic surgery. We designed an observational, descriptive, retrospective analysis of tests ordered for patients scheduled for such surgery before and after the protocol was applied. Results: Fewer tests were ordered after the protocol was introduced. We detected no statistically significant differences in relation to type of surgery planned or postoperative complications. Conclusions: Patients about to undergo outpatient dermatologic surgery under local anesthesia who have no unusual health risks may not require preoperative testing

Recommendations on Testing Before Outpatient Dermatologic Surgery. / Recomendaciones en la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria.

INTRODUCTION: Short-duration ambulatory surgery for the removal of skin tumors under local anesthesia is increasingly common in dermatology. Preoperative assessment has traditionally targeted the identification of any unknown diseases or other health conditions that might lead to changes in plans for anesthesia or surgery. Hospitals and specialists differ greatly in the tests they order in patients about to undergo outpatient dermatologic surgery given that hardly any finding would be likely to contraindicate or lead to changes in the procedure. This study aimed to provide guidance for those ordering tests before outpatient dermatologic surgery. METHODS: In 2017 our hospital developed a protocol to standardize preoperative testing for outpatient dermatologic surgery. We designed an observational, descriptive, retrospective analysis of tests ordered for patients scheduled for such surgery before and after the protocol was applied. RESULTS: Fewer tests were ordered after the protocol was introduced. We detected no statistically significant differences in relation to type of surgery planned or postoperative complications. CONCLUSIONS: Patients about to undergo outpatient dermatologic surgery under local anesthesia who have no unusual health risks may not require preoperative testing.

Objetivos macro para cámaras mirrorless en fotografía dermatológica / Macro lens for mirrorless cameras in digital photography in dermatology

No disponible

Ampolla de contenido hemático a nivel lingual / Blood-filled blister on tongue

No disponible

Primera descripción ecográfica del angiosarcoma cutáneo idiopático de cabeza y cuello / First sonographic description of idiopathic Cutaneous Angiosarcoma of the Head and Neck

No disponible

Endovascular Management of Patients with Head and Neck Cancers Presenting with Acute Hemorrhage: A Single-Center Retrospective Study.

PURPOSE: Acute hemorrhage associated with cancers of the head and neck is a life-threatening condition that requires immediate action. The aim of this study was to assess the safety and efficacy of endovascular embolization for acute hemorrhage in patients with head and neck cancers. MATERIALS AND METHODS: Data were retrospectively collected from patients with head and neck cancers who underwent endovascular embolization to treat acute hemorrhage. The primary endpoint was the rate of immediate control of hemorrhage during the first 24 h after embolization. The secondary endpoints were technical or clinical complications, rate of re-hemorrhage 24 h after the procedure, time from embolization to re-hemorrhage, hospitalization time, mortality rate, and time from embolization to death. RESULTS: Fifty-one patients underwent endovascular embolization. The primary endpoint was achieved in 94% of patients. The rate of technical complications was 5.8%, and no clinical complication was observed. Twelve patients (23.5%) had hemorrhage recurrence after an average time of 127.5 days. The average hospitalization time was 7.4 days, the mortality rate during the follow-up period was 66.6%, and the average time from embolization to death was 132.5 days. CONCLUSION: Endovascular embolization to treat acute hemorrhage in patients with head and neck cancers is a safe and effective method for the immediate control of hemorrhage and results in a high rate of hemorrhage control. Larger studies are necessary to determine which treatment strategy is best for improving patient outcomes.

Delay from fracture to hospital admission: a new risk factor for hip fracture mortality?

UNLABELLED: The relationship between surgical timing and hip fracture mortality is unknown in the context of developing countries where large delays to surgery are common. We observed that delay from fracture to hospital admission is associated with decreased survival after a hip fracture. INTRODUCTION: To examine the relationship between the time interval from fracture to surgery as well as its subcomponents (time from fracture to hospital admission and time from admission to surgery) and hip fracture survival. METHODS: The medical records of all patients aged 60 years and older admitted to a public university hospital in the city of Rio de Janeiro with a primary diagnosis of hip fracture between 1995 and 2000 were reviewed. Survival to hospital discharge and at 1 year were examined. RESULTS: Among 343 patients included in the study, there were 18 (5.3%) in-hospital deaths, and 297 (86.6%) patients remained alive 1 year after surgery. Very long delays from the time of fracture to hospital admission (mean 3 days) and from hospital admission to surgery (mean 13 days) were identified. Increased time from fracture to hospital admission was associated with reduced survival to hospital discharge (hazard ratio [HR] 1.09, 95% CI 1.03-1.15, p = 0.005) and reduced survival at 1 year after surgery (HR 1.07, 95% CI 1.03-1.10, p < 0.001). The interval of time from hospital admission to surgery was not associated with reduced survival to hospital discharge (HR 1.03, 95% CI 0.96-1.10, p = 0.379) or at 1 year after surgery (HR 1.03, 95% CI 0.99-1.07, p= 0.185). CONCLUSIONS: If the association estimated in our study is causal, our results provide evidence that some hip fracture-related deaths could be prevented by improved patient access to appropriate and timely hospital care in the context of a developing country.

Candidemia in a brazilian tertiary hospital: microbiological and clinical features over a six-year period

Yeasts are becoming a common cause of nosocomial fungal infections in immunocompromised patients. Such infections often develop into sepsis with high mortality rates. The aim of this study was to evaluate some of the numerous factors associated with the development of candidemia. Medical records were retrospectively analyzed of 98 Candida spp. patients. Results showed that the most prevalent risk factors for developing candidemia were: antibiotics and antifungal agents (93.9% and 79.6%, respectively); the use of central venous catheter (93.9%); mechanical ventilation (73.5%); and parenteral nutrition (60.2%). The main species of Candida found were: C. parapsilosis (37.76%), C. albicans (33.67%); and others (28.57%). C. glabrata showed the highest mortality rate (75%), followed by C. tropicalis (57.1%) and C. albicans (54.5%). The elevated mortality rate found in this study indicates that preventive measures against candidemia must be emphasized in hospitals.(AU)

Candida spp: manual identification (reference method) and automated identification (Vitek system platform)

Yeasts are becoming a common cause of nosocomial fungal infections that affect immunocompromised patients. Such infections can evolve into sepsis, whose mortality rate is high. This study aimed to evaluate the viability of Candida species identification by the automated system Vitek-Biomerieux (Durham, USA). Ninety-eight medical charts referencing the Candida spp. samples available for the study were retrospectively analyzed. The system Vitek-Biomerieux with Candida identification card is recommended for laboratory routine use and presents 80.6% agreement with the reference method. By separate analysis of species, 13.5% of C. parapsilosis samples differed from the reference method, while the Vitek system wrongly identified them as C. tropicalis, C. lusitaneae or as Candida albicans. C. glabrata presented a discrepancy of only one sample (25%), and was identified by Vitek as C. parapsilosis. C. guilliermondii also differed in only one sample (33.3%), being identified as Candida spp. All C. albicans, C. tropicalis and C. lusitaneae samples were identified correctly.

Referenciamento e adequação da grade hospitalar para partos na região sul de São Paulo / Referencing and adequacy of the grid for hospital deliveries in southern Sao Paulo

Dentro das normas padronizadas ao bom atendimento à gestante e recém–nascido (RN), é fundamental a disponibilização pela Rede Pública de pronto acesso ao atendimento hospitalar, garantindo condições adequadas para o parto e assistência ao RN. Desta forma, é imprescindível que as referências sejam definidas baseadas em critérios de disponibilidade dos serviços e distância entre a origem de residência e os hospitais. Para a efetividade da grade de referência é importante que os serviços conheçam e divulguem adequadamente a grade entre as pacientes e que as façam cientes dos benefícios e importância de respeitá-la(AU)

Referenciamento e adequação da grade hospitalar para partos na região sul de São Paulo

Dentro das normas padronizadas ao bom atendimento à gestante e recém–nascido (RN), é fundamental a disponibilização pela Rede Pública de pronto acesso ao atendimento hospitalar, garantindo condições adequadas para o parto e assistência ao RN. Desta forma, é imprescindível que as referências sejam definidas baseadas em critérios de disponibilidade dos serviços e distância entre a origem de residência e os hospitais. Para a efetividade da grade de referência é importante que os serviços conheçam e divulguem adequadamente a grade entre as pacientes e que as façam cientes dos benefícios e importância de respeitá-la

Referenciamento e adequação da grade hospitalar para partos na região sul de São Paulo / Referencing and adequacy of the grid for hospital deliveries in southern Sao Paulo

Dentro das normas padronizadas ao bom atendimento à gestante e recém–nascido (RN), é fundamental a disponibilização pela Rede Pública de pronto acesso ao atendimento hospitalar, garantindo condições adequadas para o parto e assistência ao RN. Desta forma, é imprescindível que as referências sejam definidas baseadas em critérios de disponibilidade dos serviços e distância entre a origem de residência e os hospitais. Para a efetividade da grade de referência é importante que os serviços conheçam e divulguem adequadamente a grade entre as pacientes e que as façam cientes dos benefícios e importância de respeitá-la.