Incidence of acute kidney injury post cardiac surgery: a comparison of the AKIN and KDIGO criteria.

BACKGROUND AND OBJECTIVES: Data on urine output have not been routinely presented to define cardiac surgery-related acute kidney injury (AKI). We evaluated the incidence of AKI after cardiac surgery based on the AKIN and KDIGO criteria (considering serum creatinine concentration and urine output in the first 72 hours postoperatively) and compared the performance of the 2 criteria for AKI staging. METHODS: This was a prospective cohort study of adult patients undergoing coronary artery bypass grafting (CABG), valve replacement, or CABG + valve replacement between October 2017 and April 2018 at a single institution. Patients were excluded if baseline creatinine concentration (measured within 7 days before surgery) was ≥ 2.5 mg.dL-1. Patients were evaluated for the development of AKI based on changes in urine output and serum creatinine concentration, measured daily from postoperative day 1 to 7, according to the AKIN and KDIGO criteria, which were then compared. RESULTS: A total of 198 patients were included. AKI occurred in 83.8% by AKIN and in 82.8% by KDIGO, when using both urine output and serum creatinine concentration as defining criteria. Using serum creatinine concentration alone, the incidence of AKI fell to 27.3% by AKIN and to 24.7% by KDIGO. A kappa coefficient of 0.98 was obtained between the AKIN and KDIGO criteria. CONCLUSIONS: Almost perfect agreement was found between AKIN and KDIGO. AKI may be underdiagnosed after cardiac surgery if serum creatinine concentration is used as the only defining criterion. Our findings underscore the fundamental importance of using the urine output criterion in the assessment of patients at risk for AKI.

Patient safety in an endoscopy unit: an observational retrospective analysis of reported incidents.

INTRODUCTION: Patient safety is a serious public health with serious implications on morbidity, mortality, and quality of life of patients, in addition to negatively affecting the public image of healthcare institutions and professionals. It requires further investigation, especially in specialties lacking published data, such as endoscopy. OBJECTIVE: To analyze patient safety incidents reported in a gastrointestinal endoscopy unit of a tertiary hospital in southern Brazil. METHODS: This retrospective, cross-sectional study quantitatively described patient safety incidents related to endoscopic procedures. The sample consisted of reports of incidents that occurred from 2015 to 2017. The data were descriptively analysed, and the study was approved by the relevant research ethics committee. RESULTS: Overall, 42,863 endoscopic procedures were performed and 167 reports were submitted in the period, accounting for a prevalence of incidents of 0.38%. Most incidents did not result in unnecessary harm to patients (76.6%). The most prevalent incidents were those related to patient identification, followed by those related to pathology exams, exam reports, gastrointestinal perforations, skin lesions, falls and medication errors. The rate of adverse events (harm to patient) in patients undergoing any endoscopic procedure was 0.06%. CONCLUSIONS: The incidence of unnecessary harm (adverse event) associated with any endoscopic procedure was relatively low in this study. However, the identification of reported incidents is crucial for evaluating and improving the quality of care provided to patients.

Abordagem clínica e terapêutica do vitiligo / Clinical and therapeutical approach of vitiligo

O vitiligo é uma leucodermia idiopática adquirida que resulta da perda de melanócitos na epiderme. A sua patogênese ainda não foi esclarecida, mas a teoria autoimune é a mais aceita, sendo a base de muitas modalidades de tratamento. Diante do grande impacto que esta doença provoca na qualidade de vida do paciente, é de extrema importância o conhecimento adequado do seu manejo clínico e das opções terapêuticas disponíveis.

Vitiligo is an acquired idiopathic leukoderma resulting from epidermal melanocytes loss. Its pathogenesis is not clear, but the autoimmune theory is the most accepted one, substantiating the basis of many treatment modalities. Given the great impact in life quality caused by this disorder, the knowledge of its appropriate clinical management and therapeutic options is of great relevance.

Manejo da síndrome de reconstituição imunológica / Immune reconstitution syndrome management

Com o aumento da incidência de pessoas infectadas pelo HIV e também dos portadores de outras condições clínicas que levam à imunossupressão, é fundamental o reconhecimento da Síndrome de Resconstituição Imunológica, bem como o entendimento de seu manejo. O objetivo deste artigo é fazer uma revisão sobre seu manejo, tão pouco discutido.

The Diagnosis of Immune Reconstitution Inflammatory Syndrome as well as the understanding of its management is extremely important considering the increasing incidence of HIV infected patients and of other medical conditions that lead to immunosuppression. The goal of this article is to review the management of this syndrome, sometimes neglected.

Crise tireotóxica / Thyrotoxic crisis

A Crise Tireotóxica (CT) é uma emergência endocrinológica que permanece um desafio tanto diagnóstico quanto terapêutico. A CT não apresenta alterações laboratoriais específicas, sendo clínicos os critérios diagnósticos. Seus sintomas correspondem a de um hipertireoidismo exacerbado e o tratamento baseia-se em medidas que bloqueiem a secreção e os efeitos dos hormônios tireoidianos.

Thyroid Storm (TS) is an endocrine emergency that remains a challenge for both diagnostics and therapeutics. The TS features no specific laboratory abnormalities, being the diagnosis made on clinical basis. The symptoms are those of an exaggerated hyperthyroidism and its treatment is based on measures that block the secretion and the effects of thyroid hormones.