Gender gaps in Mathematics and Language: The bias of competitive achievement tests.

This research paper examines the extent to which high-stakes competitive tests affect gender gaps in standardized tests of Mathematics and Language. To this end, we estimate models that predict students' results in two national standardized tests: a test that does not affect students' educational trajectory, and a second test that determines access to the most selective universities in Chile. We used data from different gender twins who took these tests. This strategy allows us to control, through household fixed effects, the observed and unobserved household characteristics. Our results show that competitive tests negatively affect women. In Mathematics, according to both tests, there is a gender gap in favor of men, which increases in the university entrance exam, especially for high-performance students. As the literature review shows, women are negatively stereotyped in Mathematics, so this stereotype threat could penalize high-achieving women, that is, those that go against the stereotype. In Language tests, women outperform men in the standardized test taken in high school, but the situation is reversed in the university entrance exam. From our analysis of Chilean national data, we find no evidence that the gender effect observed in the competitive test depends on the students' achievement level. Following the literature, this gender gap may be linked to women's risk aversion, lower self-confidence, lower preference for competition, as well as the effect of answering a test under time pressure.

Neural Networks to Recognize Patterns in Topographic Images of Cortical Electrical Activity of Patients with Neurological Diseases.

Software such as EEGLab has enabled the treatment and visualization of the tracing and cortical topography of the electroencephalography (EEG) signals. In particular, the topography of the cortical electrical activity is represented by colors, which make it possible to identify functional differences between cortical areas and to associate them with various diseases. The use of cortical topography with EEG origin in the investigation of diseases is often not used due to the representation of colors making it difficult to classify the disease. Thus, the analyses have been carried out, mainly, based on the EEG tracings. Therefore, a computer system that recognizes disease patterns through cortical topography can be a solution to the diagnostic aid. In view of this, this study compared five models of Convolutional Neural Networks (CNNs), namely: Inception v3, SqueezeNet, LeNet, VGG-16 and VGG-19, in order to know the patterns in cortical topography images obtained with EEG, in Parkinson's disease, Depression and Bipolar Disorder. SqueezeNet performed better in the 3 diseases analyzed, with Parkinson's disease being better evaluated for Accuracy (88.89%), Precison (86.36%), Recall (91.94%) and F1 Score (89.06%), the other CNNs had less performance. In the analysis of the values of the Area under ROC Curve (AUC), SqueezeNet reached (93.90%) for Parkinson's disease, (75.70%) for Depression and (72.10%) for Bipolar Disorder. We understand that there is the possibility of classifying neurological diseases from cortical topographies with the use of CNNs and, thus, creating a computational basis for the implementation of software for screening and possible diagnostic assistance.

Percolation theory for the recognition of patterns in topographic images of the cortical activity.

Electroencephalogram (EEG) is one of the mechanisms used to collect complex data. Its use includes evaluating neurological disorders, investigating brain function and correlations between EEG signals and real or imagined movements. The Topographic Image of Cortical Activity (TICA) records obtained by the EEG make it possible to observe, through color discrimination, the cortical areas that represent greater or lesser activity. Percolation Theory (PT) reveals properties on the aspects of fluid spreading from a central point, these properties being related to the aspects of the medium, topological characteristics and ease of penetration of a fluid in materials. The hypothesis presented so far considers that synaptic activities originate in points and spread from them, causing different areas of the brain to interact in a diffusive associative behavior, generating electric and magnetic fields by the currents that spread through the brain tissue and have an effect on the scalp sensors. Brain areas spatially separated create large-scale dynamic networks that are described by functional and effective connectivity. The proposition is that this phenomenon behaves like a fluidic spreading, so we can use the PT, through the topological analysis we detect specific signatures related to neural phenomena that manifest changes in the behavior of synaptic diffusion. This signature must be characterized by the Fractal Dimension (FD) values of the scattering clusters, these values will be used as properties in the k-Nearest Neighbors (kNN) method, an TICA will be categorized according to the degree of similarity to the preexisting patterns. In this context, our hypothesis will consolidate as a more computational resource in the service of medicine and another way that opens with the possibility of analysis and detailed inferences of the brain through TICA that go beyond a simply visual observation, as it happens in the present day.

Conocimientos de los estudiantes de medicina sobre cólera en una universidad pública / Knowledge of Medical Students on cholera at a public university

Resumen Introducción. El cólera es una enfermedad infecciosa de comportamiento epidémico, que sigue amenazando la salud pública. En 2010 estalló un brote en Haití cuya letalidad inicial fue de 6,4%, posiblemente por falta de conocimientos del personal médico sobre su manejo. La letalidad se estabilizó alrededor del 1%, pero existe el riesgo que la epidemia llegue a Colombia y haya médicos sin adecuado conocimiento para su intervención. Objetivo. Determinar el nivel de conocimientos sobre el cólera que tienen los estudiantes de Medicina de una universidad en Colombia. Materiales y métodos. Estudio observacional de corte transversal. Previo consentimiento informado, se aplicó una encuesta sobre conocimientos del cólera a estudiantes de Medicina que ya habían aprobado los cursos de ciencias básicas, infecciosas y epidemiología. Resultados. Participaron 323 estudiantes, con promedio de edad de 22 años, 50,8% hombres. Los niveles de conocimiento fueron independientes de edad y sexo, pero aumentan con el nivel académico (p=0,031). Los conocimientos sobre signos clínicos, vía de transmisión y población vulnerable, fueron acertados por más del 90% de los participantes; mientras que saberes sobre configuración del brote, uso de antibióticos y comportamiento reciente del cólera, fueron respondidos adecuadamente por menos del 23% de ellos. Conclusión. Los estudiantes de Medicina tienen conocimientos insuficientes para garantizar un adecuado manejo de un brote de cólera, sobre todo en lo concerniente al uso de antibióticos y la prevención de la trasmisión de la enfermedad.

Abstract Introduction. Cholera is an infectious disease with epidemic behavior. Despite scientific advances, it stills a threat for public health. In 2010, an outbreak exploded in Haiti, its initial lethality was as high as 6.4% and then stabilized near of 1%, possibly because lack of knowledge about management by medical staff. There is a risk that epidemic arrives to Colombia and finds a similar scenery.- Objective. To determine the knowledge level about cholera in medical students of an University of Colombia. Materials and methods. This is an observational, analytical, cross sectional study. Prior informed consent, we applied a survey about cholera knowledge to medical students who had already approved the basic sciences, infectology and epidemiology courses. Results. The participants were 323 students whose average age was 22 years, 50.8 % were men. Knowledge levels had nothing to do with age and sex, but increase with academic level (p=0,031). Knowledge about clinical signs, transmission via and populations at risk, were correct in more than 90% of participants; as long as knowledge about outbreak configuration, use of antibiotics and recent behavior of cholera were answered appropriated by less of 23% of them. Conclusion. Medical students have not enough knowledge to guarantee an adequate management of a cholera outbreak, antibiotics use, and prevention of disease.

Complicaciones postquirúrgicas en intervenciones correctivas de labio y paladar hendido en pacientes pediátricos de un hospital de tercer nivel en Bucaramanga, Colombia 2013-2016 / Complications following surgical treatment of cleft lip and palate in pediatric patients of a third-level hospital in Bucaramanga, Colombia 2013-2016

Resumen Introducción: las hendiduras orofaciales son las malformaciones congénitas de cabeza y cuello más frecuentes en el mundo, con gran importancia epidemiológica por su alto impacto sobre la calidad de vida de la población. Este impacto está dado en gran parte por la presencia de complicaciones postquirúrgicas, por lo que es importante conocerlas, con el fin de aplicar estrategias de prevención o de corrección temprana. Objetivo: identificar las principales complicaciones posquirúrgicas de la cirugía correctiva de labio hendido, paladar hendido o ambos, en un hospital de tercer nivel en Bucaramanga, Santander, Colombia. Materiales y métodos: estudio observacional descriptivo de corte transversal. Se obtuvo la información de los registros de historias clínicas médicas, de pacientes cuya intervención quirúrgica fue realizada durante el período de enero de 2013 a diciembre de 2016. Resultados: se obtuvieron registros de 55 pacientes. La presentación conjunta de labio y paladar hendido fue la anomalía craneoencefálica más frecuente (70,9%). La complicación más frecuente fue la fístula oronasal (23,9% de pacientes con compromiso del paladar), seguida por la dehiscencia de la herida quirúrgica (3,6%). Se encontró un mayor porcentaje de complicaciones postquirúrgicas en el sexo masculino. Conclusión: la complicación postquirúrgica de corrección de labio y/o paladar hendido más frecuente encontrada en la muestra fue la fístula oronasal. MÉD.UIS. 2018;31(2):25-32.

Abstract Introduction: the orofacial clefts are the most frequent congenital malformations of the head and neck in the world, with great epidemiological importance for their impact on the quality of life of the population. This impact is largely due to the presence of postsurgical complications, which is why it is important to know them, in order to apply prevention strategies or early correction. Objective: to identify the main complications following surgical treatment of cleft lip, cleft palate or both, in a third level hospital in Bucaramanga, Santander, Colombia. Materials and methods: descriptive cross-sectional study. The information was obtained from the medical records of patients whose surgical intervention was performed during the period from january 2013 to december 2016. Results: records of 55 patients were obtained. The joint presentation of cleft lip and palate was the most frequent craniofacial anomaly (70.9%). The most frequent complication was oronasal fistula (23.9% of patients with compromised palate), followed by dehiscence of the surgical wound (3.6%). A higher percentage of postoperative complications was found in the male sex. Conclusion: the postoperative complication of lip and/or cleft palate correction most frequently found in the sample was the oronasal fistula. MÉD.UIS. 2018;31(2):25-32.

Patients with Rheumatoid Arthritis and Chronic Pain Display Enhanced Alpha Power Density at Rest.

Patients with chronic pain due to neuropathy or musculoskeletal injury frequently exhibit reduced alpha and increased theta power densities. However, little is known about electrical brain activity and chronic pain in patients with rheumatoid arthritis (RA). For this purpose, we evaluated power densities of spontaneous electroencephalogram (EEG) band frequencies (delta, theta, alpha, and beta) in females with persistent pain due to RA. This was a cross-sectional study of 21 participants with RA and 21 healthy controls (mean age = 47.20; SD = 10.40). EEG was recorded at rest over 5 min with participant's eyes closed. Twenty electrodes were placed over five brain regions (frontal, central, parietal, temporal, and occipital). Significant differences were observed in depression and anxiety with higher scores in RA participants than healthy controls (p = 0.002). Participants with RA exhibited increased average absolute alpha power density in all brain regions when compared to controls [F (1.39) = 6.39, p = 0.016], as well as increased average relative alpha power density [F (1.39) = 5.82, p = 0.021] in all regions, except the frontal region, controlling for depression/anxiety. Absolute theta power density also increased in the frontal, central, and parietal regions for participants with RA when compared to controls [F (1, 39) = 4.51, p = 0.040], controlling for depression/anxiety. Differences were not exhibited on beta and delta absolute and relative power densities. The diffuse increased alpha may suggest a possible neurogenic mechanism for chronic pain in individuals with RA.

From Reduction to Apocope: Final Poststressed Vowel Devoicing in Brazilian Portuguese.

This is a study of final poststressed vowel devoicing following /s/ in Brazilian Portuguese. We contradict the literature describing it as deletion by arguing, first, that the vowel is not deleted, but overlapped and devoiced by the /s/, and, second, that gradient reduction with devoicing may lead to apocope diachronically. The following results support our view: (1) partially devoiced vowels are centralized; (2) centralization is inversely proportional to duration; (3) total devoicing is accompanied by lowering of the /s/ centroid; (4) the /s/ noise seems to be lengthened when the vowel is totally devoiced; (5) aerodynamic tests reveal that lengthened /s/ has a final vowel-like portion, too short to be voiced; (6) lengthened /s/ favors vowel recovery in perceptual tests. This seems to be a likely path from reduction to devoicing to listener-based apocope.

Analgesic effect of cathodal transcranial current stimulation over right dorsolateral prefrontal cortex in subjects with muscular temporomandibular disorders: study protocol for a randomized controlled trial.

BACKGROUND: Temporomandibular disorders are a group of orofacial pain conditions that are commonly identified in the general population. Like many other chronic pain conditions, they can be associated with anxiety/depression, which can be related to changes in the activity of the dorsolateral prefrontal cortex. Some studies have demonstrated clinical improvement in subjects with chronic pain who are given therapeutic neuromodulation. Transcranial direct current stimulation is a noninvasive brain stimulation technique that allows the modulation of neuronal membranes. This therapy can enhance or inhibit action potential generation in cortical neurons. In some instances, medications acting in the central nervous system may be helpful despite their adverse side effects. It is important to determine if cathodal transcranial direct current stimulation over the dorsolateral prefrontal cortex, an area that modulates emotion and motor cortex excitability, has an analgesic effect on chronic temporomandibular disorders pain. METHOD/DESIGN: The investigators will run a randomized, controlled crossover double blind study with 15 chronic muscular temporomandibular disorder subjects. Each subject will undergo active (1 mA and 2 mA) and sham transcranial direct current stimulation. Inclusion criteria will be determined by the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire, with subjects who have a pain visual analogic scale score of greater than 4/10 and whose pain has been present for the previous 6 months, and with a State-Trait Anxiety Inventory score of more than 42. The influence of transcranial direct current stimulation will be assessed through a visual analogic scale, quantitative sensory testing, quantitative electroencephalogram, and the State-Trait Anxiety Inventory score. DISCUSSION: Some studies have demonstrated a strong association between anxiety/depression and chronic pain, where one may be the cause of the other. This is especially true in chronic temporomandibular disorders, and breaking this cycle may have an effect over the symptoms and associated dysfunction. We believe that by inhibiting activity of the dorsolateral prefrontal cortex though cathodal transcranial direct current stimulation, there may be a change in both anxiety/depression and pain level. Transcranial direct current stimulation may emerge as a new tool to be considered for managing these patients. We envision that the information obtained from this study will provide a better understanding of the management of chronic temporomandibular disorders. TRIAL REGISTRATION: This trial was registered at clinicaltrials.gov on 24 May 2014 (Identifier: NCT02152267 ).

Associação entre sexo e mortalidade em pacientes com sepse: os hormônios sexuais influenciam o desfecho? / Gender and mortality in sepsis: do sex hormones impact the outcome?

OBJETIVO: Análise comparativa da mortalidade em dois subgrupos de pacientes com sepse, diferenciados pela idade e sexo, admitidos na unidade de cuidados intensivos de um hospital de ensino. MÉTODOS: De dezembro de 2005 a abril de 2008, de um total de 628 pacientes admitidos na unidade de cuidados intensivos, 133 tinham o diagnóstico de sepse e foram separados em dois subgrupos com base na idade: subgrupo G1, com idades entre 14 - 40 anos e subgrupo G2, com idade acima de 50 anos. Os pacientes com idades entre 41 e 50 anos (n = 8) foram excluídos. Os subgrupos foram caracterizados quanto aos dados demográficos, indicadores prognósticos (escore APACHE II, disfunção orgânica e choque circulatório) e desfecho (mortalidade). RESULTADOS: O subgrupo G1 (n = 44) tinha 27 (61,4 por cento) pacientes do sexo feminino e o subgrupo G2 (n = 81) tinha 40 (49,4 por cento) pacientes do sexo feminino. A média do escore APACHE II, incidência de disfunção de múltiplos órgãos e progressão para choque circulatório não foram estatisticamente diferente entre pacientes femininos e masculinos em ambos os subgrupos. A taxa de mortalidade geral foi menor em mulheres do que em homens do subgrupo G1 (P = 0,04); no subgrupo G2 foi observada uma tendência inversa. CONCLUSÕES: Em pacientes com sepse, mulheres abaixo dos quarenta anos de idade, portanto em período fértil, tiveram menor mortalidade do que homens; houve uma tendência para menor mortalidade entre homens com mais de 50 anos.

OBJECTIVE: Comparative assessment of the mortality rates of two septic patients' ages and/or gender subgroups, admitted to the intensive care unit of a university hospital. METHODS: From December 2005 to April 2008, from a total of 628 patients, 133 were admitted to the intensive care unit with sepsis and included into two age subgroups: (G1) 14 - 40 years old and (G2) more than 50 years old. Patients aged between 41 and 50 years old (n = 8) were excluded. Demographic data, prognostic indicators (APACHE II score, organ dysfunction and circulatory shock) and outcome (mortality) were analyzed. RESULTS: Of the G1 patients (n = 44), 27 were female (61.4 percent), and in G2 (n = 81), 40 were female (49.4 percent). For both groups, mean APACHE II scores, multi-organ dysfunction and progression to circulatory shock rates were not significantly different between female and male patients. For G1, overall mortality rate was lower in female than in male patients (P = 0.04), while for G2, the opposite trend was observed. CONCLUSIONS: In this sample, reproductive age female patients younger than 40 years old showed lower mortality rates compared with age-matched male patients; for patients older than 50 years old, male patients had lower mortality rates than female patients.

Gender and mortality in sepsis: do sex hormones impact the outcome? / Associação entre sexo e mortalidade em pacientes com sepse: os hormônios sexuais influenciam o desfecho?

OBJECTIVE: Comparative assessment of the mortality rates of two septic patients' ages and/or gender subgroups, admitted to the intensive care unit of a university hospital. METHODS: From December 2005 to April 2008, from a total of 628 patients, 133 were admitted to the intensive care unit with sepsis and included into two age subgroups: (G1) 14 - 40 years old and (G2) more than 50 years old. Patients aged between 41 and 50 years old (n = 8) were excluded. Demographic data, prognostic indicators (APACHE II score, organ dysfunction and circulatory shock) and outcome (mortality) were analyzed. RESULTS: Of the G1 patients (n = 44), 27 were female (61.4%), and in G2 (n = 81), 40 were female (49.4%). For both groups, mean APACHE II scores, multi-organ dysfunction and progression to circulatory shock rates were not significantly different between female and male patients. For G1, overall mortality rate was lower in female than in male patients (P = 0.04), while for G2, the opposite trend was observed. CONCLUSIONS: In this sample, reproductive age female patients younger than 40 years old showed lower mortality rates compared with age-matched male patients; for patients older than 50 years old, male patients had lower mortality rates than female patients.

Oral Granulocytic Sarcoma: A case report

Granulocytic sarcoma (GS) is a localized infiltrate of immature granulocytes in an extramedullary site. This lesion is most frequently associated with leukemia, but can occur associated with others myeloproliferative disorders. GS can affect virtually any part of the body, but lesions in the oral cavity are rare, with only 37 cases described. Case Description: We present a rare case of GS in a 23-year-old female, with a prior history of acute myeloid leukemia, presenting with a solitary mandibular swelling in the region of the erupting 3rd lower left molar. After biopsy, conventional immunohistochemical stains were positive for CD45 (hematological marker) and myeloid markers, such as myeloperoxidase, and CD68, demonstrating myeloid lineage with monocytic cells differentiation, suggesting the diagnosis of GS associated to Acute Myeloid Leukemia (AML-M5). Clinical implication: Although GS is a rare tumor in oral cavity, and its diagnosis is usually difficult, the clinician must know about its existence to make differential diagnosis (AU)

Oral granulocytic sarcoma: a case report.

UNLABELLED: Granulocytic sarcoma (GS) is a localized infiltrate of immature granulocytes in an extramedullary site. This lesion is most frequently associated with leukemia, but can occur associated with other myeloproliferative disorders. GS can affect virtually any part of the body, but oral lesions are rare, with only 37 cases described. CASE DESCRIPTION: We present a case of GS in a 23-year-old female, with a prior history of acute myeloid leukemia, presenting with a solitary mandibular swelling in the region of the erupting lower left 3rd molar. After biopsy, conventional immunohistochemical stains were positive for CD45 (hematological marker) and myeloid markers, such as myeloperoxidase, and CD68, demonstrating a myeloid lineage with monocytic cell differentiation, suggesting the diagnosis of GS associated to AML-M5. CLINICAL IMPLICATION: Although GS is a rare tumor in the oral cavity, and its diagnosis is usually difficult, the clinician must know of its existence in order to make a differential diagnosis.

Terminalidade e cuidados paliativos na unidade de terapia intensiva: [revisão] / End of life and palliative care in intensive care unit: [review]

O objetivo da presente revisão foi avaliar o estado atual do conhecimento sobre doença terminal e cuidados paliativos em unidade de terapia intensiva. Identificar as questões-chave e sugerir uma agenda de pesquisa sobre essas questões. A Associação Brasileira de Medicina Intensiva organizou um fórum especifico para o debate de doenças terminais na unidade de terapia intensiva, onde participaram profissionais experientes em medicina intensiva. Esses profissionais foram subdivididos em 3 subgrupos, que discutiram: comunicação em unidade de terapia intensiva, decisões diante de um doente terminal e cuidados/ações paliativas na unidade de terapia intensiva. As informações e referências bibliográficas foram copiladas e trabalhadas através de um site de acesso restrito. Os trabalhos ocorreram em 12 horas quando foram realizadas discussões sistematizadas seguindo o método Delphi modificado. Foram elaboradas definições sobre a terminalidade. A adequada comunicação foi considerada de primordial importância para a condução do tratamento de um paciente terminal. Foram descritas barreiras de comunicação que devem ser evitadas sendo definidas técnicas para a boa comunicação. Foram também definidos os critérios para cuidados e ações paliativas nas unidades de terapia intensiva, sendo considerada fundamental a aceitação da morte, como um evento natural, e o respeito à autonomia e não maleficência do paciente. Considerou-se aconselhável a suspensão de medicamentos fúteis, que prolonguem o morrer e a adequação dos tratamentos não fúteis privilegiando o controle da dor e dos sintomas para o alívio do sofrimento dos pacientes com doença terminal. Para a prestação de cuidados paliativos a pacientes críticos e seus familiares, devem ser seguidos princípios e metas que visem o respeito às necessidades e anseios individuais. Os profissionais da unidade de terapia intensiva envolvidos com o tratamento desses pacientes são submetidos a grande estresse e tensão...

The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on palliative care is desirable.

Perfil dos pacientes com lúpus eritematoso sistêmico, internados na unidade de terapia intensiva de um hospital universitário de Fortaleza / Characteristics of patients with systemic lupus erythematosus admitted to the intensive care unit in a brazilian teaching hospital

OBJETIVOS: Face à demanda de nosso serviço, buscamos descrever as características e a evolução dos pacientes com lúpus eritematoso sistêmico (LES) internados na unidade de terapia intensiva do Hospital Universitário Walter Cantídio. MÉTODOS: Os pacientes foram, retrospectivamente, caracterizados quanto aos dados demográficos, tempo de diagnóstico da doença, disfunções orgânicas e exames laboratoriais à admissão, suportes terapêuticos usados durante a internação, tempo de internação hospitalar prévio à admissão, tempo de permanência na unidade, reinternações e desfecho evolutivo. Foram avaliados os escores Systemic Lupus Erythematosus Disease Activity (SLEDAI) e Acute Physiological and Chronic Health Evaluation II (APACHE II) à admissão, a mortalidade prevista e a razão de mortalidade padronizada. RESULTADOS: No período de novembro de 2003 a outubro de 2006, 1.052 pacientes foram admitidos à UTI, 50 (4,75 por cento) dos quais com LES. Houve predomínio do sexo feminino (88,2 por cento), com média de idade de 30,3 ± 12,8 anos. A mediana do tempo de diagnóstico da doença foi de 67 meses. As disfunções mais prevalentes à admissão foram: renal (70,6 por cento), cardiovascular (61,8 por cento), respiratória (55,9 por cento) e neurológica (55,9 por cento). As principais disfunções motivadoras da admissão na unidade de terapia intensiva foram: respiratória (38,2 por cento), cardiovascular (29,4 por cento) e neurológica (29,4 por cento). Os tratamentos mais utilizados foram: hemocomponentes (44,1 por cento), fármacos vasopressores (41,2 por cento), ventilação mecânica (35,3 por cento) e diálise (23,5 por cento). A média do SLEDAI foi 15 ± 12,2 pontos e a do APACHE II foi 19,3 ± 6,8 pontos, com mortalidade prevista de 37,6 por cento. Registrou-se óbito de 20,6 por cento após 48 horas na unidade de terapia intensiva e 8,8 por cento, com menos de 48h. A razão de mortalidade padronizada foi 0,78. Os pacientes com APACHE II maior que 18 pontos, com ...

OBJECTIVES: Due to the high incidence in our service, we did object on this study describe the features and outcome of patients with systemic lupus erythematosus (SLE) admitted to the intensive care unit of Walter Cantídio University Hospital METHODS: Patients were restrospectively characterized according to demography parameters, time of diagnosis of SLE, organ dysfunction and laboratorial parameters at admission, supportive therapies during their stay, length of stay in the hospital before admission, length of stay in the unit, readmission to the unit and outcome. We also evaluated Systemic Lupus Erythematosus Disease Activity (SLEDAI) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, expected mortality and standardized mortality ratio. RESULTS: From November 2003 to October 2006, 1,052 patients were admitted to the intensive care unit. Fifty patients had SLE and were included in this retrospective study. Of the 50 patients with SLE admitted to the ICU, 88.2 percent were female. The mean age was 30.3 ± 12.8 years. The median time of diagnosis of SLE was 67 months. The most common organ dysfunctions were renal (70.6 percent), cardiovascular (61.8 percent), respiratory (55.9 percent) and neurological (55.9 percent). The main reasons for admission to the ICU were respiratory (38.2 percent), cardiologic (29.4 percent) and neurological (29.4 percent) dysfunctions. Among the intensive care therapies, 44.1 percent of the patients needed blood products, 41.2 percent vasopressor agents and 35.3 percent mechanical ventilation, 23.5 percent dialysis. The mean SLEDAI score was 15.0 ± 12.2. The mean APACHE II score was 19.3 ± 6.8, with a predicted mortality rate of 37.6 percent. The actual mortality rate in ICU was 29.4 percent, with 8.8 percent before 48 hours. The standardized mortality ratio was 0.78. Patients with APACHE II > 18, with more than 3 acute organ involvements, leukopenia (< 4000 cells/mm3) and gastrointestinal ...

Validação de um escore de alerta precoce pré-admissão na unidade de terapia intensiva / Validation of an early warning score in pre-intensive care unit

JUSTIFICATICA E OBJETIVOS: O prognóstico dos pacientes admitidos em unidade de terapia intensiva (UTI) tem relação com sua gravidade nos momentos que precedem a internação. O objetivo deste estudo foi avaliar a gravidade dos pacientes 12, 24 e 72h antes da admissão na UTI, bem como qual o parâmetro mais prevalente nesses pacientes e correlacionar o Modified Early Warning Score (MEWS) no pré-UTI com o desfecho (sobrevivência versus óbito), respectivo. MÉTODO: Análise retrospectiva de 65 pacientes, nas 72 horas que antecederam a admissão na UTI, no perío-do de julho a outubro de 2006. RESULTADOS: O APACHE II médio foi 22,2 ± 7,9 pontos, a mortalidade real de 54,6 por cento e a taxa de mortalidade padronizada foi 1,24. O MEWS médio foi 3,7 ± 0,2; 4,0 ± 0,2 e 5,1 ± 0,2 pontos, calculado 72, 48 e 24h antes da admissão na UTI, respectivamente. Registrou-se um percentual crescente de pacientes com MEWS > 3 pontos nas 72, 48 e 24h antes da admissão - 43,8 por cento, 59,4 por cento e 73,4 por cento, respectivamente. Dentre os parâmetros fisiológicos, a freqüência respiratória foi a que mais contribuiu para a pontuação do MEWS. A mortalidade foi maior entre os pacientes com MEWS > 3 pontos já 72 horas antes da admissão. Entre os pacientes que faleceram, verificou-se um aumento significativo no MEWS médio, 24 horas antes da admissão à UTI (em relação ao registrado, 72 horas antes), fato não identificado nos sobreviventes. CONCLUSÕES: O MEWS identificou com fidelidade a gravidade dos pacientes admitidos na UTI, sugerindo ser um escore confiável à aplicação nas instancias que precedem a UTI.

BACKGROUND AND OBJECTIVES: Prognosis of patients in the intensive care unit (ICU) has a relation with their severity just before admission. The Modified Early Warning Score (MEWS) was used to evaluate the severe condition of patients 12, 24 and 72 hours before admission in the ICU, assess the most prevalent parameters and correlate the MEWS before ICU with the outcome (survival versus death). METHODS: Retrospective analyses of 65 patients consecutively admitted to the ICU from July to October, 2006 evaluating the physiological parameters 72 hours prior to admission. RESULTS: APACHE II mean was 22.2 ± 7.9 points, mortality was 54.6 percent and standardized mortality ratio means was 1.24. MEWS means were 3.7 ± 0.2; 4.0 ± 0.2 and 5.1 ± 0.2 points, calculated 72, 48 and 24 hours previous to ICU admission, respectively. An increasing percentage of patients with MEWS > 3 points within 72, 48 and 24 hours before admission - 43.8 percent, 59.4 percent and 73.4 percent, respectively was recorded. Among the included physiological parameters respiratory rate contributed the most to the MEWS. Highest mortality was found in patients with MEWS > 3 points already found 72 hours before admission. Patients who died presented with a significant increase in the MEWS 24 hours prior to admission to the ICU (in relation to the MEWS recorded 72 hours before) but the situation was not identified in survivors. CONCLUSIONS: MEWS closely identified the severity of patients admitted to the ICU, suggesting that it can be a reliable score, useful in the situations preceding the ICU.

Validation of an early warning score in pre-intensive care unit. / Validação de um escore de alerta precoce pré-admissão na unidade de terapia intensiva.

BACKGROUND AND OBJECTIVES: Prognosis of patients in the intensive care unit (ICU) has a relation with their severity just before admission. The Modified Early Warning Score (MEWS) was used to evaluate the severe condition of patients 12, 24 and 72 hours before admission in the ICU, assess the most prevalent parameters and correlate the MEWS before ICU with the outcome (survival versus death). METHODS: Retrospective analyses of 65 patients consecutively admitted to the ICU from July to October, 2006 evaluating the physiological parameters 72 hours prior to admission. RESULTS: APACHE II mean was 22.2 ± 7.9 points, mortality was 54.6% and standardized mortality ratio means was 1.24. MEWS means were 3.7 ± 0.2; 4.0 ± 0.2 and 5.1 ± 0.2 points, calculated 72, 48 and 24 hours previous to ICU admission, respectively. An increasing percentage of patients with MEWS > 3 points within 72, 48 and 24 hours before admission - 43.8%, 59.4% and 73.4%, respectively was recorded. Among the included physiological parameters respiratory rate contributed the most to the MEWS. Highest mortality was found in patients with MEWS > 3 points already found 72 hours before admission. Patients who died presented with a significant increase in the MEWS 24 hours prior to admission to the ICU (in relation to the MEWS recorded 72 hours before) but the situation was not identified in survivors. CONCLUSIONS: MEWS closely identified the severity of patients admitted to the ICU, suggesting that it can be a reliable score, useful in the situations preceding the ICU.

Characteristics of patients with systemic lupus erythematosus admitted to the intensive care unit in a brazilian teaching hospital. / Perfil dos pacientes com lúpus eritematoso sistêmico, internados na unidade de terapia intensiva de um hospital universitário de Fortaleza.

OBJECTIVES: Due to the high incidence in our service, we did object on this study describe the features and outcome of patients with systemic lupus erythematosus (SLE) admitted to the intensive care unit of Walter Cantídio University Hospital METHODS: Patients were restrospectively characterized according to demography parameters, time of diagnosis of SLE, organ dysfunction and laboratorial parameters at admission, supportive therapies during their stay, length of stay in the hospital before admission, length of stay in the unit, readmission to the unit and outcome. We also evaluated Systemic Lupus Erythematosus Disease Activity (SLEDAI) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, expected mortality and standardized mortality ratio. RESULTS: From November 2003 to October 2006, 1,052 patients were admitted to the intensive care unit. Fifty patients had SLE and were included in this retrospective study. Of the 50 patients with SLE admitted to the ICU, 88.2% were female. The mean age was 30.3 ± 12.8 years. The median time of diagnosis of SLE was 67 months. The most common organ dysfunctions were renal (70.6%), cardiovascular (61.8%), respiratory (55.9%) and neurological (55.9%). The main reasons for admission to the ICU were respiratory (38.2%), cardiologic (29.4%) and neurological (29.4%) dysfunctions. Among the intensive care therapies, 44.1% of the patients needed blood products, 41.2% vasopressor agents and 35.3% mechanical ventilation, 23.5% dialysis. The mean SLEDAI score was 15.0 ± 12.2. The mean APACHE II score was 19.3 ± 6.8, with a predicted mortality rate of 37.6%. The actual mortality rate in ICU was 29.4%, with 8.8% before 48 hours. The standardized mortality ratio was 0.78. Patients with APACHE II > 18, with more than 3 acute organ involvements, leukopenia (< 4000 cells/mm3) and gastrointestinal or metabolic involvement had higher mortality in the intensive care unit. CONCLUSION: Although the severity of patients at admission to the ICU, demonstrated by APACHE II and the acute dysfunctions, the outcomes of analysed patients sugest susceptibility to the therapy.

End of life and palliative care in intensive care unit. / Terminalidade e cuidados paliativos na unidade de terapia intensiva.

The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on palliative care is desirable.

Déficit de base à admissão na unidade de terapia intensiva: um indicador de mortalidade precoce / Base deficit at intensive care unit admission: an early mortality indicator

JUSTIFICATIVA E OBJETIVOS: O déficit de base é considerado um indicador de lesão tissular, choque e reanimação. O objetivo deste estudo foi estabelecer uma associação entre o déficit de base na admissão dos pacientes internados em unidade de terapia intensiva (UTI) e seu prognóstico. MÉTODO: Estudo retrospectivo com análise de 110 pacientes admitidos consecutivamente na UTI, durante o período de 01 de junho a 31 de dezembro de 2006. RESULTADOS: Houve predomínio do sexo feminino, com idade média de 54,2 ± 18,7 anos. O tempo médio de permanência foi 6,5 ± 7,4 dias e o APACHE médio foi de 21 ± 8,1 pontos. A razão de mortalidade padronizada foi 0,715. A mortalidade dos pacientes com déficit de base superior a 6 mEq/L foi maior (38,9 por cento) que a daqueles com déficit menor (ou excesso) (20,6 por cento); p < 0,05. Os pacientes com mortalidade precoce (primeiras 48h de UTI) tiveram maior déficit de base (7,75 ± 8,33 mEq/L) que os sobreviventes (3,17 ± 5,43 mEq/L); p < 0,05. Não se documentou associação entre o tempo de permanência e o déficit de base. CONCLUSÕES: O déficit de base revelou-se significativamente maior entre os pacientes que faleceram precocemente, principalmente quando superior a 6 mEq/L.

BACKGROUND AND OBJECTIVES: Base deficit is considered an indicator of tissue injury, shock and resuscitation. The objective of this study was to establish an association between base deficit obtained on the admission of patients in intensive care unit (ICU) and their prognosis. METHODS: A retrospective study with analysis of 110 patients admitted consecutively in the ICU, during the period of June to December 2006. RESULTS: There was a predominance of women, with age mean 54.2 ± 18.7 years old. Length of stay in ICU was 6.5 ± 7.4 days and the mean APACHE II score was 21 ± 8.1 points. The standardized mortality ratio was 0.715. Mortality was higher in patients with base deficit > 6 mEq/L (38.9 percent) than in those with base deficit < 6 mEq/L (20.6 percent); p < 0.05. Patients with early mortality had lower base deficit (7.75 ± 8.33 mEq/L) than survivors (3.17 ± 5.43 mEq/L); p < 0.05. Patients with permanence in ICU until 7 days and patients that stayed in this unit for more than 7 days had similar base deficit. CONCLUSIONS: Base deficit had been associated with early mortality during ICU internment. Base deficit > 6 mEq/L is a marker of significant mortality.

[Base deficit at intensive care unit admission: an early mortality indicator]. / Déficit de base à admissão na unidade de terapia intensiva: um indicador de mortalidade precoce.

BACKGROUND AND OBJECTIVES: Base deficit is considered an indicator of tissue injury, shock and resuscitation. The objective of this study was to establish an association between base deficit obtained on the admission of patients in intensive care unit (ICU) and their prognosis. METHODS: A retrospective study with analysis of 110 patients admitted consecutively in the ICU, during the period of June to December 2006. RESULTS: There was a predominance of women, with age mean 54.2 ± 18.7 years old. Length of stay in ICU was 6.5 ± 7.4 days and the mean APACHE II score was 21 ± 8.1 points. The standardized mortality ratio was 0.715. Mortality was higher in patients with base deficit > 6 mEq/L (38.9%) than in those with base deficit < 6 mEq/L (20.6%); p < 0.05. Patients with early mortality had lower base deficit (7.75 ± 8.33 mEq/L) than survivors (3.17 ± 5.43 mEq/L); p < 0.05. Patients with permanence in ICU until 7 days and patients that stayed in this unit for more than 7 days had similar base deficit. CONCLUSIONS: Base deficit had been associated with early mortality during ICU internment. Base deficit > 6 mEq/L is a marker of significant mortality.