ABSTRACT
Atropine, a competitive antagonist of acetylcholine muscarinic receptors, is commonly used to treat severe bradycardia by blocking parasympathetic activity. We present a rare case of hypertensive emergency following atropine administration, with only one previous report in the literature. A 78-year-old woman with essential hypertension and hypercholesterolemia was admitted to the cardiac intensive care unit for non-ST segment elevation myocardial infarction. During coronary angiography, an occlusion of the right coronary artery was identified. While removing the diagnostic catheter through the right radial artery, the patient experienced intense pain and discomfort, accompanied by a vasovagal reflex characterized by bradycardia and hypotension. Intravenous atropine (0.5mg) was administered, leading to a rapid rise in heart rate with frequent ventricular ectopy. Subsequently, a progressive and exaggerated elevation in arterial blood pressure occurred, peaking at 294/121mmHg approximately 10min after atropine administration. The patient developed hypertensive acute pulmonary edema, successfully treated with intravenous nitroglycerine (10mg) and furosemide (60mg). Blood pressure normalized after approximately 14min. The exact mechanism of atropine-induced hypertensive emergency remains unknown. While hypertensive emergencies with atropine are exceedingly rare, healthcare professionals should be aware of this potential effect and be prepared for prompt intervention.(AU)
La atropina, un antagonista competitivo de los receptores muscarínicos de acetilcolina, se utiliza comúnmente para tratar la bradicardia severa al bloquear la actividad parasimpática. Presentamos un caso raro de emergencia hipertensiva después de la administración de atropina, con solo un informe previo en la literatura. Una mujer de 78 años con hipertensión esencial e hipercolesterolemia fue ingresada en la unidad de cuidados intensivos cardíacos por infarto agudo de miocardio sin elevación del segmento ST. Durante la angiografía coronaria, se identificó una oclusión de la arteria coronaria derecha. Mientras se retiraba el catéter diagnóstico a través de la arteria radial derecha, la paciente experimentó un intenso dolor y malestar, acompañado de un reflejo vasovagal caracterizado por bradicardia e hipotensión. Se administró atropina intravenosa (0,5 mg), lo que provocó un rápido aumento de la frecuencia cardíaca con frecuente ectopia ventricular. Posteriormente, ocurrió una elevación progresiva y exagerada de la presión arterial, alcanzando un máximo de 294/121 mmHg aproximadamente 10 minutos después de la administración de atropina. La paciente desarrolló edema pulmonar agudo hipertensivo, tratado con éxito con nitroglicerina intravenosa (10 mg) y furosemida (60 mg). La presión arterial se normalizó después de aproximadamente 14 minutos. El mecanismo exacto de la emergencia hipertensiva inducida por atropina sigue siendo desconocido. Aunque las emergencias hipertensivas con atropina son excepcionalmente raras, los profesionales de la salud deben estar al tanto de este efecto potencial y estar preparados para intervenir rápidamente.(AU)
Subject(s)
Humans , Female , Aged , Atropine/administration & dosage , Atropine/adverse effects , Bradycardia , Hypercholesterolemia , Coronary Angiography , Drug-Related Side Effects and Adverse Reactions , Inpatients , Physical Examination , Hypertension , Arterial PressureABSTRACT
Atropine, a competitive antagonist of acetylcholine muscarinic receptors, is commonly used to treat severe bradycardia by blocking parasympathetic activity. We present a rare case of hypertensive emergency following atropine administration, with only one previous report in the literature. A 78-year-old woman with essential hypertension and hypercholesterolemia was admitted to the cardiac intensive care unit for non-ST segment elevation myocardial infarction. During coronary angiography, an occlusion of the right coronary artery was identified. While removing the diagnostic catheter through the right radial artery, the patient experienced intense pain and discomfort, accompanied by a vasovagal reflex characterized by bradycardia and hypotension. Intravenous atropine (0.5mg) was administered, leading to a rapid rise in heart rate with frequent ventricular ectopy. Subsequently, a progressive and exaggerated elevation in arterial blood pressure occurred, peaking at 294/121mmHg approximately 10min after atropine administration. The patient developed hypertensive acute pulmonary edema, successfully treated with intravenous nitroglycerine (10mg) and furosemide (60mg). Blood pressure normalized after approximately 14min. The exact mechanism of atropine-induced hypertensive emergency remains unknown. While hypertensive emergencies with atropine are exceedingly rare, healthcare professionals should be aware of this potential effect and be prepared for prompt intervention.
Subject(s)
Hypertension , Hypertensive Crisis , Female , Humans , Aged , Atropine/adverse effects , Bradycardia/chemically induced , Hypertension/drug therapy , Heart RateABSTRACT
Objective To assess children's functional outcomes one year after critical illness and identify which factors influenced these functional outcomes. Design Ambispective cohort study. Setting Pediatric intensive care unit (PICU) in a tertiary academic center. Participants Children (1 month17-year-old) and their caregivers. Interventions None. Main variables of interest Demographic, clinical, and functional status. Results Of 242 patients screened, 128 completed the year follow-up. These children had significant changes in functional status over time (p<0.001). The functional decline occurred in 62% of children at discharge and, after one year, was persistent in 33%. Age>12 months was a protective factor against poor functional outcomes in two regression models (p<0.05). A moderately abnormal functional status and a severely/very severely abnormal functional status at discharge increased the risks of poor functional outcomes by 4.14 (95% CI 1.0216.72; p=0.04), and 4.76 (CI 95% 1.1919.0; p=0.02). A functional decline at discharge increased by 6.86 (95%CI: 2.16-21.79; p=0.001) the risks of children's long-term poor functional outcomes, regardless of the FSS scores. Conclusion This is the first study evaluating long-term functional outcomes after pediatric critical illnesses in Latin America. Our findings show baseline data and raise relevant questions for future multicentre studies in this field in Latin America, contributing to a better understanding of the effects of critical illnesses on long-term functional outcomes in children (AU)
Objetivo Evaluar los resultados funcionales de los niños un año después de la enfermedad crítica e identificar qué factores influyeron en estos resultados funcionales. Diseño Estudio de cohorte ambispectivo. Entorno Unidad de Cuidados Intensivos Pediátricos (UCIP) de un centro académico terciario. Participantes Niños (1 mes-17 años) y sus cuidadores. Intervenciones Ninguna. Principales variables de interés Estado demográfico, clínico y funcional. Resultados De 242 niños examinados, 128 completaron el seguimiento. Estos niños y adolescentes cambiaron su estado funcional significativamente con el tiempo (p<0,001). El deterioro funcional ocurrió en el 62% de los niños al momento del alta y, después de un año, fue persistente en el 33%. La edad >12 meses fue un factor protector contra malos resultados funcionales en dos modelos de regresión (p<0,05). Un estado funcional moderadamente anormal y severamente/muy severamente anormal al alta aumentó el riesgo de resultados funcionales deficientes en 4,14 (IC95% 1,02-16,72; p=0,04) y 4,76 (IC95% 1,19-19,0; p=0,02). Una disminución funcional en el momento del alta aumentó los riesgos de resultados funcionales deficientes a largo plazo en 6,86 (IC95% 2,16-21,79; p=0,001), independientemente de las puntuaciones de FSS. Conclusión Este es el primer estudio que evalúa los resultados funcionales a largo plazo después de enfermedades críticas pediátricas en América Latina. Nuestros datos son básicos y plantean preguntas relevantes para futuros estudios multicéntricos en América Latina y pueden contribuir a una mejor comprensión de los efectos de enfermedades críticas en los resultados funcionales a largo plazo en niños (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Intensive Care Units, Pediatric , Critical Illness/therapy , Recovery of Function , Patient Discharge , Treatment Outcome , Cohort StudiesABSTRACT
OBJECTIVE: To assess children's functional outcomes one year after critical illness and identify which factors influenced these functional outcomes. DESIGN: Ambispective cohort study. SETTING: Pediatric intensive care unit (PICU) in a tertiary academic center. PARTICIPANTS: Children (1 month-17-year-old) and their caregivers. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographic, clinical, and functional status. RESULTS: Of 242 patients screened, 128 completed the year follow-up. These children had significant changes in functional status over time (p<0.001). The functional decline occurred in 62% of children at discharge and, after one year, was persistent in 33%. Age>12 months was a protective factor against poor functional outcomes in two regression models (p<0.05). A moderately abnormal functional status and a severely/very severely abnormal functional status at discharge increased the risks of poor functional outcomes by 4.14 (95% CI 1.02-16.72; p=0.04), and 4.76 (CI 95% 1.19-19.0; p=0.02). A functional decline at discharge increased by 6.86 (95%CI: 2.16-21.79; p=0.001) the risks of children's long-term poor functional outcomes, regardless of the FSS scores. CONCLUSION: This is the first study evaluating long-term functional outcomes after pediatric critical illnesses in Latin America. Our findings show baseline data and raise relevant questions for future multicentre studies in this field in Latin America, contributing to a better understanding of the effects of critical illnesses on long-term functional outcomes in children.
Subject(s)
Critical Illness , Patient Discharge , Humans , Child , Infant , Cohort Studies , Intensive Care Units, PediatricABSTRACT
Abstract We report the first known occurrence of Panstrongylus megistus (Burmeister, 1835) (Hemiptera, Reduviidae, Triatominae) in the Metropolitan Region of São Paulo, Brazil. In 2018, adult specimens were sent by residents to the competent authorities and, in the inspection of the property, a large focus associated with a marsupial nest was found. This finding reinforces the importance of the species in the state of São Paulo, serves as an alert for epidemiological surveillance and extends the species colonization area in the state of São Paulo.
Resumo Relatamos a primeira ocorrência de Panstrongylus megistus (Burmeister, 1835) (Hemiptera, Reduviidae, Triatominae) na Região Metropolitana de São Paulo, Brasil. Em 2018, espécimes adultos foram enviados por residentes e a pesquisa na propriedade constatou a presença de um grande foco associado a um ninho marsupial. Este achado reforça a importância da espécie no estado de São Paulo, serve de alerta para a vigilância epidemiológica e amplia a área de colonização da espécie no estado de São Paulo.
Subject(s)
Animals , Panstrongylus , Triatominae , Reduviidae , BrazilABSTRACT
We report the first known occurrence of Panstrongylus megistus (Burmeister, 1835) (Hemiptera, Reduviidae, Triatominae) in the Metropolitan Region of São Paulo, Brazil. In 2018, adult specimens were sent by residents to the competent authorities and, in the inspection of the property, a large focus associated with a marsupial nest was found. This finding reinforces the importance of the species in the state of São Paulo, serves as an alert for epidemiological surveillance and extends the species colonization area in the state of São Paulo.
Subject(s)
Panstrongylus , Reduviidae , Triatominae , Animals , BrazilABSTRACT
We report the first known occurrence of Panstrongylus megistus (Burmeister, 1835) (Hemiptera, Reduviidae, Triatominae) in the Metropolitan Region of São Paulo, Brazil. In 2018, adult specimens were sent by residents to the competent authorities and, in the inspection of the property, a large focus associated with a marsupial nest was found. This finding reinforces the importance of the species in the state of São Paulo, serves as an alert for epidemiological surveillance and extends the species colonization area in the state of São Paulo
Relatamos a primeira ocorrência de Panstrongylus megistus (Burmeister, 1835) (Hemiptera, Reduviidae, Triatominae) na Região Metropolitana de São Paulo, Brasil. Em 2018, espécimes adultos foram enviados por residentes e a pesquisa na propriedade constatou a presença de um grande foco associado a um ninho marsupial. Este achado reforça a importância da espécie no estado de São Paulo, serve de alerta para a vigilância epidemiológica e amplia a área de colonização da espécie no estado de São Paulo.
ABSTRACT
We report the first known occurrence of Panstrongylus megistus (Burmeister, 1835) (Hemiptera, Reduviidae, Triatominae) in the Metropolitan Region of São Paulo, Brazil. In 2018, adult specimens were sent by residents to the competent authorities and, in the inspection of the property, a large focus associated with a marsupial nest was found. This finding reinforces the importance of the species in the state of São Paulo, serves as an alert for epidemiological surveillance and extends the species colonization area in the state of São Paulo
ABSTRACT
BACKGROUND: The intrinsic ageing and photoaged skin present biomechanical and morphological differences, which are reflected in the appearance of roughness, superficial and deep wrinkles, atrophy, reduced elasticity, hypo- and hyperpigmentation and actinic keratosis. OBJECTIVE: To evaluate and compare the characteristics of the flexor (with a predominance of intrinsic ageing) and extensor (chronically exposed to sunlight and other environmental factors, with a predominance of photoageing) skin surfaces of the forearms. METHODS: Interventional, prospective, diagnostic study, including 23 females, aged over 60 years. The extensor and flexor faces of forearms were compared in relation to clinical parameters and non-invasive instrumental measurements, such as skin surface, elasticity, hydration as well as dermal thickness and echogenicity. RESULTS: Regarding the water content of the stratum corneum, the flexor face presented an average value higher than the extensor face. The average of measures obtained through images of high-frequency ultrasound demonstrated greater echogenicity of flexor face compared to the extensor face. The measurements of the skin surface showed significant differences between the faces. The roughness and scaliness were lower in the flexor face. Regarding the depth of wrinkles, there was no significant difference between the faces. The average of the measurements was slightly higher in the flexor face, which demonstrated that wrinkles are present in the intrinsic ageing and photoageing. The presence of elastosis and the reduction in elasticity in the clinical aspect of the photoaged face of forearms were according to the results of the non-invasive measurements. CONCLUSION: Meaningful differences in the biophysical characteristics of the extensor and flexor faces of the forearms were detected. Because the non-invasive instrumental measurements correlated with clinical findings, they may represent useful tools to assess efficacy and safety of skin ageing treatments in clinical research.
Subject(s)
Forearm , Skin Aging , Environmental Exposure , Female , Humans , Male , Middle Aged , Prospective Studies , SunlightABSTRACT
Abstract We report the first known occurrence of Panstrongylus megistus (Burmeister, 1835) (Hemiptera, Reduviidae, Triatominae) in the Metropolitan Region of São Paulo, Brazil. In 2018, adult specimens were sent by residents to the competent authorities and, in the inspection of the property, a large focus associated with a marsupial nest was found. This finding reinforces the importance of the species in the state of São Paulo, serves as an alert for epidemiological surveillance and extends the species colonization area in the state of São Paulo.
Resumo Relatamos a primeira ocorrência de Panstrongylus megistus (Burmeister, 1835) (Hemiptera, Reduviidae, Triatominae) na Região Metropolitana de São Paulo, Brasil. Em 2018, espécimes adultos foram enviados por residentes e a pesquisa na propriedade constatou a presença de um grande foco associado a um ninho marsupial. Este achado reforça a importância da espécie no estado de São Paulo, serve de alerta para a vigilância epidemiológica e amplia a área de colonização da espécie no estado de São Paulo.
ABSTRACT
OBJECTIVE: To evaluate the incidence of subglottic stenosis in children undergoing endotracheal intubation. METHODS: Children in the paediatric intensive care unit of a tertiary care hospital were considered eligible for inclusion if they received endotracheal intubation for more than 24 hours. After extubation, children underwent flexible fibre-optic nasolaryngoscopy. Based on this first evaluation, they were divided into two groups: 'acute normal', with mild laryngeal alterations or normal findings; and 'acute alterations', with moderate to severe laryngeal alterations. Further laryngoscopic follow up (7-10 days later) was undertaken for those children in the acute normal group who developed symptoms during follow up (after discharge from the intensive care unit), and for all children in the acute alterations group. Children were then classified into two final groups: 'normal final examination', with no chronic changes; and 'subglottic stenosis'. RESULTS: We included 123 children. The incidence of subglottic stenosis was 11.38 per cent (95 per cent confidence interval, 6.63-17.94 per cent). All the children who developed subglottic stenosis had had moderate to severe alterations immediately after extubation. CONCLUSION: This incidence of subglottic stenosis is quite high and needs further investigation to identify risk factors.
Subject(s)
Glottis/physiopathology , Intubation, Intratracheal/adverse effects , Laryngostenosis/epidemiology , Child , Child, Preschool , Humans , Incidence , Laryngoscopy , Laryngostenosis/diagnosis , Laryngostenosis/etiology , Male , Prevalence , Prospective StudiesABSTRACT
AIMS: This study evaluated the agreement of growth charts proposed by the National Center for Health Statistics (NCHS/1977), Centers for Disease Control and Prevention (CDC/2000) and World Health Organization (WHO/2006). METHODS: Were assessed children between 0 and 5 years old, hospitalized in the pediatric wards of a Brazilian school hospital. Z-score indexes: stature/age (S/A), weight/age (W/A) and weight/stature (W/S) was evaluated, in each of the three references (NCHS, CDC and WHO). ANOVA and test Bland & Altman and Lin plots were used in the comparison of the 3 charts. The agreement of the nutritional state categories was also evaluated, through kappa coefficient. The study was approved by the Institution's Research Ethics Committee. RESULTS: The study analyzed 337 children, whose median age was 0.52 (IQR: 0.21-1.65) years, 65.3% of them were below 1 year old, 60.2% were male and 50% hospitalized due to acute respiratory disease. Lower Z-scores of W/A and S/A were obtained with the WHO charts and lower W/S with the CDC chart. High correlation and agreement were observed among the criteria, but more patients were classified as presenting shortness through the WHO criteria. CDC and WHO criteria were more rigorous than the NCHS criteria for the diagnosis of underweight (W/A) and malnutrition (W/S). CONCLUSION: Despite the strong agreement of the 3 charts, the adoption of the WHO charts seems to be more helpful for the children's nutritional screening for admission, as it enables to detect a higher number of malnourished children or at nutritional risk, who will benefit from an early intervention.
Subject(s)
Growth Charts , Analysis of Variance , Body Height/physiology , Body Weight/physiology , Brazil , Centers for Disease Control and Prevention, U.S. , Child, Preschool , Female , Hospitalization , Humans , Infant , Male , National Center for Health Statistics, U.S. , Nutritional Status , Reference Standards , United States , World Health OrganizationABSTRACT
UNLABELLED: JUSTIFICATION AND OBJECTIVE: Identify changes in the nutritional status of hospitalized children is fundamental for the early establishment of interventions. This study aims at describing the prevalence of undernutrition at admission and over the weeks of in-hospital stay in pediatric patients and evaluate the association between nutritional status and length of in-hospital stay. MATERIALS AND METHODS: A cohort study was carried out. It followed all the in-patients admitted to the general pediatric unit, composed of 72 beds, in the Hospital de Clínicas de Porto Alegre (HCPA), in the south of Brazil, from 20 march to 20 october in 2004. Patients who were between 1 month and 12 years of age and who had been admitted for clinical or/and surgical reasons were included. Those with Down Syndrome or without clinical condition and/or stature for weight measurement were excluded. Anthropometric data were collected up to 48 hours after admission and, weekly, up to hospital discharge (at admission, on 7th, 14th, and 21st day after admission). In children below 5 years of age, the standard defined by the World Heath Organization (WHO/2006) for the classification of the z-score for the stature/age (S/A), weight/age (W/A) and weight/stature (W/S) scores was used. In children from 5 to 10 years of age, the standards of the National Center for Health Statistics (NCHS, 1977) were used to classify the same rates as reference values. In children above 10 years of age, the classification of the Body Mass Index (BMI) was used (OMS/1995). In order to compare the z-scores over the four evaluation moments, analysis of variance (ANOVA) was used for repeated measurements, with Bonferroni's Post-Hoc test, and, for the evaluation of the in-hospital stay length, according to the nutritional status, Kaplan-Meier's survival curve, in the SPSS program, version 12.0, was used. RESULTS: 426 patients were included in the study. 57% of them were male and 50.7% were below one year of age. At admission, the prevalence of malnutrition was 10%, 18%, 21% and 14.7%, according to the W/S, W/A, S/A, and BMI criteria, respectively. Improvement of the nutritional status over the in-hospital stay was observed (at admission to 21st day) in children below 5 years (Z-score W/A: from -1.49 +/- 2.47 to -0.85 +/- 2.36, p = 0.001, and S/A: from -1.69 +/- 2.05 to -1.21 +/- 1.99, p = 0.007) and also in 5 to 10 years of age (S/A: from -0.43 +/- 1.31 to -0.30 +/- 1.37, p = 0.024). Undernourished patients, compared to nourished patients (according to the W/S rate for children below 10 years of age and BMI for above 10 years of age), showed a higher probability of remaining hospitalized (HR = 1.41; IC95%: 1.02-1.92). CONCLUSIONS: The prevalence of malnutrition by the W/S score was about half the prevalence found by the W/A and W/A indices, possibly reflecting a chronic impairment of the nutritional status. Undernutrition was confirmed as a health problem, once undernourished patients remained hospitalized for longer periods, which is a treatable problem as it was observed an improvement in the nutritional status rates over in-hospital stay.
Subject(s)
Child, Hospitalized , Malnutrition/epidemiology , Nutritional Status , Brazil , Child , Child, Preschool , Cohort Studies , Female , Hospitals, General , Humans , Infant , Length of Stay/statistics & numerical data , Male , PrevalenceABSTRACT
Estudou-se o efeito de diferentes fontes de ácidos graxos insaturados (óleo de canola e semente de linhaça), acrescidas de diferentes teores de alfa-tocoferol nas dietas de poedeiras, sobre a composição de ácidos graxos da gema do ovo foi estudado. Foram utilizadas 288 galinhas da linhagem Babcock que receberam dietas com 6 por cento de óleo de canola, 20 por cento de semente de linhaça moída ou 3 por cento de óleo de canola e 10 por cento de linhaça moída com teores de 0, 100 e 200UI/kg de alfa-tocoferol. As dietas com 20 por cento de semente de linhaça proporcionaram teores mais elevados de ácidos graxos poliinsaturados no ovo com aumento, em particular, dos teores de ácido alfa-linolênico e EPA (ácido eicosapentaenóico) e diminuição de ácido araquidônico na gema. Os teores de vitamina E contidos nas rações experimentais não determinaram alteração significativa na deposição dos diferentes ácidos graxos na gema dos ovos, exceto com relação aos ácidos graxos saturados.
The effect of dietary sources of polyunsaturated fatty acids - canola oil and flaxseed - with different vitamin E supplementation on the fatty acid deposition into the eggs of 288 Babcock laying hens was investigated. Birds were fed diets containing 6 percent of canola oil, 20 percent of flaxseed or a combination of 3 percent of canola oil and 10 percent of flaxseed, enriched with 0, 100 or 200Ul of dl-alpha-tocopheril acetate. The inclusion of flaxseed in the diets increased the yolk polyunsaturated fatty acids, mainly alpha-linolenic acid and EPA (eicosapentaenoic acid). The concentration of alpha-tocopherol in the diet did not change the egg yolk, fatty acids deposition but changed the saturated fatty acids deposition.
Subject(s)
Fatty Acids, Unsaturated/adverse effects , Birds , Brassica napus/adverse effects , Flax/adverse effects , Eggs/adverse effects , Vitamin E/adverse effects , Plant Oils/adverse effectsABSTRACT
OBJETIVO: Determinar a prevalência dos diferentes modos de morrer e identificar limites terapêuticos em pacientes de uma Unidade de Tratamento Intensivo Pediátrica (UTIP) de hospital universitário. MÉTODOS: Estudo retrospectivo, baseado na revisäo de prontuários dos pacientes que morreram na UTIP do Hospital de Clínicas de Porto Alegre, no período de 1º julho de 1996 a 30 junho de 1997. Para modo de morrer, adotou-se critérios de: näo resposta às medidas de ressuscitaçäo cardiorrespiratória (NRRST), morte cerebral (MC), retirada/näo-adoçäo de medidas de suporte de vida (R/NASV) e decisäo de näo reanimar (DNR). Para causa de morte, adotou-se critério de falências de órgäos. RESULTADOS: Dos 61 óbitos ocorridos no período, entraram no estudo 44 pacientes, cuja mediana de idade foi 28 meses. Todos tiveram como causa de morte a falência de múltiplos órgäos. Vinte e seis pacientes (59 por cento) eram do grupo I (NRRST e MC), enquanto 18 (41 por cento) do grupo II (R/NASV e DNR). No grupo II, 83 por cento dos pacientes tinham doença crônica e/ou debilitante (p = 0,017; chi²). Os motivos de admissäo mais prevalentes foram necessidade de terapias de suporte (55 por cento), ventilatória e cardiocirculatória, sem diferença estatística entre os grupos. A mediana do tempo de permanência na UTI foi de 5 dias, e no hospital, de 11 dias, sem significância estatística entre os dois grupos. CONCLUSÖES: Observou-se alta prevalência de modos de morrer R/NASV e DNR nos pacientes de UTIP avaliados, sugerindo condutas de limitaçäo terapêutica para eles. Näo se conseguiu avaliar o nível de participaçäo da equipe e da família nesse processo de tomada de decisöes
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric , Cause of Death , Brain Death , Brazil , Infant Mortality , Retrospective Studies , Resuscitation Orders , Hospital Mortality , Cardiopulmonary Resuscitation , Critical Care , Length of Stay , Life Support CareABSTRACT
BACKGROUND: To determine the prevalence of different modes of death and to identify therapeutic limitations in patients admitted to the Pediatric Intensive Care Unit (PICU) at a teaching hospital. METHODS: A retrospective study was carried out. Information was collected from the medical records of patients who died at the PICU of Hospital de Clínicas de Porto Alegre between July 1st, 1996 and June 30th, 1997. Four modes of death were considered: patient not responding to cardiopulmonary resuscitation methods (NRCPR), brain death (BD), withdrawal / withhold life-support measures (W/WLS) and decision not to resuscitate (DNR). For cause of death we employed the criterion of organ failure. RESULTS: Out of 61 deaths occurred during the period under analysis, 44 patients were included in the study. Patient age median was 28 months. The cause of death for all patients was multiple organ failure. Twenty-six patients (59%) were classified in group I (NRCPR and BD) and 18 (41%) in group II (W/WLS and DNR). Among patients of group II, 83% had a chronic and/or debilitating disease (p = 0.017; chi(2)). The prevalent reason for patient admission was the need for organ support (55%), both respiratory and cardiovascular. The median for duration of patient stay at the PICU was 5 days and at the hospital was 11 days. There was no statistically significant difference between the two groups in terms of reason for patient admission or duration of PICU/hospital stay. CONCLUSIONS: There was a high prevalence of W/WLS and DNR deaths among ICU patients, thus suggesting therapeutic limitation for them. We were unable to evaluate the level of participation by the medical team and by the family in this decision making process.
Subject(s)
Cause of Death , Intensive Care Units, Pediatric/statistics & numerical data , Adolescent , Brain Death , Brazil/epidemiology , Cardiopulmonary Resuscitation , Child , Child, Preschool , Female , Hospital Mortality , Humans , Infant , Infant Mortality , Infant, Newborn , Male , Resuscitation Orders , Retrospective Studies , Withholding TreatmentABSTRACT
Maytenus aquifolium (Celastraceae) and Salacia campestris (Hippocrateaceae) species accumulate friedelane and quinonemethide triterpenoids in their leaves and root bark, respectively. Enzymatic extracts obtained from leaves displayed cyclase activity with conversion of the substrate oxidosqualene to the triterpenes, 3beta-friedelanol and friedelin. In addition, administration of (+/-)5-(3)H mevalonolactone in leaves of M. aquifolium seedlings produced radio labelled friedelin in the leaves, twigs and stems, while the root bark accumulated labelled maytenin and pristimerin. These experiments indicated that the triterpenes once biosynthesized in the leaves are translocated to the root bark and further transformed to the antitumoral quinonemethide triterpenoids.
Subject(s)
Rosales/metabolism , Triterpenes/isolation & purification , Chromatography, High Pressure Liquid , Magnetic Resonance Spectroscopy , Molecular Structure , Triterpenes/chemistryABSTRACT
Colorants derived from the seeds of annatto (Bixa orellana, L.) are extensively used in the food industry. Their pecular characteristics, as that which permits obtaining water-soluble and lipid-soluble colorants through small alterations of the production process, was one of the factors responsible for the success of this pigment. It can be observed that only recently, a little over five years, efforts have been dedicated to the study of the physico-chemical characteristics of the different carotenoid structures that compose the so-called annatto colorant. The very industry that produces the colorant has only recently perceived the possibility of obtaining colorants of different hues from annatto seeds and has dedicated studies to this respect. On the other hand, complementary toxicological studies of these pigments are being demanded, putting their utilization in question, and only with the conclusion of these work can their future be evaluated.
Subject(s)
Food Coloring Agents , Food Technology/trends , Food Coloring Agents/chemistry , Seeds/chemistryABSTRACT
OBJECTIVE: To discuss ethical and legal aspects of physicians attitudes in emergency departments under the light of Brazils codes and laws.METHODS: The authors raise questions based upon case reports and comment using the medical ethical code, laws that protect children and adolescents, hospitalized children and adolescents rights statement and medical federal council decisions.RESULTS: The authors discuss child patients' rights and the parents disclosure right; the problem of domestic violence and abuse and the physician duty to denunciate this kind of practice for the child security and protection; the medical responsability even under workplace adverse conditions, as well as the concerns related to transportation of patients to another hospital; the dilemma between withholding and withdrawing life support measures at the emergency department and the prohibition to certificate death in violent death situations; the autonomy and decision-making capa-city of adolescent patients and their limitations, including violation of confidentiality.CONCLUSIONS: The commentaries presented in the article try to explain to the pediatrician how to identify ethical and legal conflicts in the emergency department and to prepare him (her) to assume attitudes based on codes and legal statements, as well as to respect the patient's rights.
