Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism.

Neuromonitoring is a critical tool for emergency rooms and intensive care units to promptly identify and treat brain injuries. The case report of a patient with status epilepticus necessitating orotracheal intubation and intravenous lorazepam administration is presented. A pattern of epileptiform activity was detected in the left temporal region, and intravenous Acyclovir was administered based on the diagnostic hypothesis of herpetic meningoencephalitis. The neurointensivist opted for multimodal non-invasive bedside neuromonitoring due to the complexity of the patient's condition. A Brain4care (B4C) non-invasive intracranial compliance monitor was utilized alongside the assessment of an optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD). Based on the collected data, a diagnosis of intracranial hypertension (ICH) was made and a treatment plan was developed. After the neurosurgery team's evaluation, a stereotaxic biopsy of the temporal lesion revealed a grade 2 diffuse astrocytoma, and an urgent total resection was performed. Research suggests that monitoring patients in a dedicated neurologic intensive care unit (Neuro ICU) can lead to improved outcomes and shorter hospital stays. In addition to being useful for patients with a primary brain injury, neuromonitoring may also be advantageous for those at risk of cerebral hemodynamic impairment. Lastly, it is essential to note that neuromonitoring technologies are non-invasive, less expensive, safe, and bedside-accessible approaches with significant diagnostic and monitoring potential for patients at risk of brain abnormalities. Multimodal neuromonitoring is a vital tool in critical care units for the identification and management of acute brain trauma as well as for patients at risk of cerebral hemodynamic impairment.

Estado de conservação de respiradores PFF-2 após uso na rotina hospitalar / Maintenance status of N95 respirator masks after use in a health care setting / Estado de conservación de respiradores PFF-2 después de su uso en la rutina hospitalaria

Visando quantificar os danos impostos a respiradores PFF-2 ao longo do tempo de uso e estimar seu período de validade na prática clínica, este estudo baseou-se na análise descritiva de máscaras cônicas do tipo PFF-2, coletadas por auxiliares de enfermagem após um, cinco, 15 e 30 dias consecutivos de uso, num hospital de referência para doenças infecciosas. Marcas de identificação pessoal foram encontradas em todos os respiradores já no primeiro dia de uso. A partir do quinto dia, todas as máscaras apresentavam sujeiras, enquanto dobraduras foram observadas em mais de 80 por cento dos equipamentos. Manchas internas e dobras foram mais freqüentes após turnos de 12 horas do que plantões de 6 horas (p < 0.05). 16,17 por cento das máscaras estavam extraviadas no quinto dia e 38.93 por cento após o 30º dia de uso. O prazo de validade do respirador PFF-2, embora não seja conveniente reutilizá-lo, deve se limitar a cinco dias.

With the purpose of assessing the damages to N95 respirator masks over time and to estimate their expiration after use in clinical practice, this study was based on the descriptive analysis of N95 cone-shaped masks collected by nursing assistants after one, five, 15, and 30 consecutive days of use. Personal identification marks were founds in every respirator already on the first day of use. From the fifth day onward, all masks presented some type of dirt while folds were observed in more than 80 percent of the devices. Internal stains and folds were more frequent among workers of the 12-hour shift in comparison to the 6-hour shift (p < 0.05). The percentage of misplaced respirators was 16.17 percent by day five and reached 38.93 percent by day thirty. Though there is no convenience in reusing N95 respirators, their expiration should not exceed 5 days of use.

En la intención de cuantificar los daños impuestos a respiradores PFF-2 a lo largo del tiempo de uso y estimar su vida útil en la práctica clínica, este estudio se basó en el análisis descriptivo de máscaras cónicas del tipo PFF-2 revisadas después de uno, cinco, quince y treinta días consecutivos de uso por auxiliares de enfermería en un hospital de referencia para enfermedades infecciosas. Ya en el primer día de uso fueron encontradas marcas de identificación personal en todos los respiradores. A partir del quinto día, todas las máscaras presentaban suciedad, mientras que fueron observados pliegues en más del 80 por ciento de los equipos. Las manchas internas y pliegues fueron más frecuentes luego de turnos de 12 horas que de guardias de 6 horas (p<0,05). 16,17 por ciento de las máscaras habían sido extraviadas hacia el quinto día, y 38,93 por ciento luego del trigésimo día de uso. El tiempo de validez del respirador PFF-2, aunque no sea conveniente reutilizarlo, debe limitarse a cinco días.

Evolução dos casos de coinfecção tuberculose/HIV com cultura positiva após alta do tratamento de tuberculose / Evolution of co-infection tuberculosis/HIV cases with positive culture after treatment outcome of tuberculosis

O objetivo do presente trabalho foi verificar a evolução de pacientes que tiveram alta por cura do tratamento contra a tuberculose (TB) quanto à ocorrência de recidiva, no período entre 2002 e 2003. O método envolveu estudo transversal retrospectivo, com os seguintes critérios de inclusão: casos de TB com cultura positiva, HIV positivo, >18 anos, curados do tratamento da TB e com seguimentoambulatorial em um serviço de referência para HIV/Aids, em São Paulo (SP), Brasil. Foram avaliadas as seguintes variáveis: idade, sexo, forma clínica, internação, tipo de caso, esquema de tratamento TB e mudança de esquema, hepatoxicidade, resistência, alcoolismo, tabagismo, usuário de drogas, HAART, CD4, carga viral e classificação da munodeficiência. Para detecção das recidivas, os pacientes foram seguidos por 6,5 anos após a cura pelo sistema de informaçãoTB-Web do Núcleo de Vigilância Epidemiológica do Instituto de Infectologia Emilio Ribas. Para avaliar a significância estatística dos resultados foram utilizados os testes qui-quadrado ou exato de Fisher. Foram estudados 39pacientes. Ocorreram sete recidivas (17,9%). Na analise univariada a nãoutilização de HAART [RR=0,11 (IC95%:0,011-0,88); p = 0,05] mostrou-se associada à recidiva. Os resultados sugerem que deva ser incentivado para pacientes coinfectados com M. tuberculosis e HIV o uso de HAART para redução da ocorrência de recidiva Evolução

[Maintenance status of N95 respirator masks after use in a health care setting]. / Estado de conservação de respiradores PFF-2 após uso na rotina hospitalar.

With the purpose of assessing the damages to N95 respirator masks over time and to estimate their expiration after use in clinical practice, this study was based on the descriptive analysis of N95 cone-shaped masks collected by nursing assistants after one, five, 15, and 30 consecutive days of use. Personal identification marks were founds in every respirator already on the first day of use. From the fifth day onward, all masks presented some type of dirt while folds were observed in more than 80% of the devices. Internal stains and folds were more frequent among workers of the 12-hour shift in comparison to the 6-hour shift (p < 0.05). The percentage of misplaced respirators was 16.17% by day five and reached 38.93% by day thirty. Though there is no convenience in reusing N95 respirators, their expiration should not exceed 5 days of use.