ABSTRACT
OBJECTIVE: To evaluate the clinical characteristics, prevalence and factors associated with delirium in critical patients from 5 to 14 years of age. DESIGN: An analytical, cross-sectional observational study was made. Delirium was assessed with the Pediatric-Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) and motor classification was established with the Delirium Rating Scale Revised-98. SETTING: A pediatric Intensive Care Unit. PATIENTS: All those admitted over a one-year period were assessed during the first 24-72h, or when possible in deeply sedated patients. EXCLUSION CRITERIA: Patients in stupor or coma, with severe communication difficulty, subjected to deep sedation throughout admission, and those with denied consent. RESULTS: Twenty-nine of the 156 assessed patients suffered delirium (18.6%) and 55.2% were hypoactive. The neurocognitive alterations evaluated by the pCAM-ICU were similar in the three motor groups. Intellectual disability (OR=17.54; 95%CI: 3.23-95.19), mechanical ventilation (OR=18.80; 95%CI: 4.29-82.28), liver failure (OR=54.88; 95%CI: 4.27-705.33), neurological disease (OR=4.41; 95%CI: 1.23-15.83), anticholinergic drug use (OR=3.23; 95%CI: 1.02-10.26), different psychotropic agents (OR=4.88; 95%CI: 1.42-16.73) and tachycardia (OR=4.74; 95%CI: 1.21-18.51) were associated to delirium according to the logistic regression analysis. CONCLUSION: The frequency of delirium and hypoactivity was high. It is therefore necessary to routinely evaluate patients with standardized instruments. All patients presented with important neurocognitive alterations. Several factors related with the physiopathology of delirium were associated to the diagnosis; some of them are modifiable through the rationalization of medical care.
Subject(s)
Critical Care , Delirium/epidemiology , Adolescent , Child , Child, Preschool , Cholinergic Antagonists/adverse effects , Cross-Sectional Studies , Delirium/etiology , Female , Humans , Intellectual Disability/complications , Intensive Care Units, Pediatric/statistics & numerical data , Liver Failure/complications , Male , Nervous System Diseases/complications , Prevalence , Psychotropic Drugs/adverse effects , Respiration, Artificial/adverse effects , Tachycardia/complicationsABSTRACT
El kéfir de agua (KA) es una bebida fermentada medianamente ácida elaborada con soluciones azucaradas y fermentada por un consorcio de microorganismos, principalmente bacterias ácido lácticas (BAL) y levaduras (LEV), embebidas en un polisacárido llamado gránulo de KA. La presencia de hongos y sus toxinas es un problema de la producción de alimentos, como Aspergillus ochraceus y sus micotoxinas especialmente en café y vino. Entre algunas alternativas que se han evaluado para su inhibición se incluyen las bacterias ácido lácticas y productos fermentados en general. El objetivo principal de esta investigación fue evaluar la capacidad del KA en inhibir o retrasar el crecimiento de A. ochraceus. Se emplearon 8 sobrenadantes libres de células (SLC) obtenidos de diferentes fermentaciones de panela con gránulos de KA y con diferentes concentraciones de ácidos orgánicos (láctico y acético). Se hicieron fermentaciones con gránulos de KA en solución de panela por periodos de 32,5 h, a 25, 30 y 37 °C. Se determinaron la cinética de acidificación; el incremento de biomasa y se hizo el recuento de los grupos de microorganismos que componen el gránulo. A 25 °C se determinó el mayor aumento de biomasa (92%). La temperatura de fermentación afectó el recuento de los microorganismos que conforman el gránulo, principalmente las BAL, disminuyendo su cantidad a la máxima temperatura de fermentación (37 °C) (1x10ˆ6 UFC ml-1), comparado con la mínima temperatura (25 °C) (6x10ˆ7 UFC ml-1). El fermento que presentó mayor actividad antifúngica fue el SLC5 (pH: 3,2; temperatura de fermentación: 30 °C). El poder inhibitorio se atribuyó a los ácidos orgánicos producidos durante la fermentación, aunque no se puede descartar que hayan actuado otras sustancias no cuantificadas. Se pudo comprobar que el KA puede fermentar y aumentar su biomasa en un sustrato como el agua de panela y que sus SLC tienen la capacidad de reducir el crecimiento de A. ochraceus.
Water kéfir (WK) is a moderately sour fermented beverage elaborated in sugar-containing solutions through fermentation by a microorganism consortium, principally lactic acid bacteria (LAB) and yeasts, embedded in a matrix of polysaccharide so-called WK grains. The presence of fungi and their toxins it is a problem for the food industry, such as Aspergillus ochraceus and their mycotoxin production especially in coffee and wine. Some alternatives that have been evaluated for their inhibition include lactic acid bacteria and generally fermented products. The main objective was to evaluate the capacity of WK to ferment a Colombian beverage made with Panela and to assess capability of this product to retard the germination of a common toxigenic fungi like Aspergillus ochraceus. 8 cell-free supernatants (CFS) were obtained from separate fermentations and with different organic acids (OA) concentrations (e. g., lactic and acetic). Different fermentations were conducted with WK in Panela broth during 32.5 h periods at 25, 30, and 37°C. We determined the kinetics of acidification of WK along with the corresponding increment in biomass and conducted a quantitation of microorganisms groups that composed the grain. The greatest biomass increase occurred at 25 °C (92%); but the fermentation temperature affected the composition of microorganisms conforming the grain, with the quantity of LAB decreasing at the highest fermentation temperatures (37 °C) (1x10ˆ6cfu ml-1), compared with the minimum temperature (25 °C) (6x10ˆ7 cfu ml-1). The CFS5 (pH 3.2; fermentation temperature 30 °C) exhibited the greatest antifungal activity. We attribute the inhibitory power of these ferments to the OA produced during fermentation, although we cannot discard the possibility of the action of other substances not specifically quantified. We concluded that WK can grow and fermentate Panela broth and that its CFS can exert an antifungal effect against A. ochraceus.
ABSTRACT
OBJECTIVES: The purpose of this study was to examine the long-term clinical outcome after percutaneous intervention of saphenous vein grafts (SVG) and to identify the predictors of major adverse cardiac events (MACE). BACKGROUND: Percutaneous interventions of SVGs have been associated with more procedural complications and higher restenosis rates compared with interventions on native vessels. METHODS: From 1993 to 1997, 1,062 patients underwent percutaneous intervention on 1,142 SVG lesions. Procedural, in-hospital and long-term clinical outcomes were recorded in a database and analyzed. RESULTS: In-hospital MACE occurred in 137 patients (13%) including death (8%), Q-wave myocardial infarction (MI) (2%) and coronary artery bypass surgery (3%). Late MACE occurred in 565 patients (54%) including death (9%), Q-wave MI (9%) and target vessel revascularization (36%). Any MACE occurred in 457 (43%) patients. Follow-up was available in 1,056 (99%) patients at 3 +/- 1 year. Univariate predictors were restenotic lesion (odds ratio [OR]: 2.47, confidence interval [CI]: 1.13 to 3.85, p = 0.0003), unstable angina (OR: 1.99, CI: 1.27 to 2.91, p = 0.04) and congestive heart failure (CHF) (OR: 1.97, CI: 1.14 to 3.24, p = 0.02) for in-hospital MACE, and peripheral vascular disease (PVD) (OR: 2.18, CI: 1.34 to 3.44, p = 0.002), intra-aortic balloon pump placement (OR: 2.08, CI: 1.13 to 3.85, p = 0.02) and previous MI (OR: 1.97, CI: 1.14 to 3.25, p = 0.007) for late MACE. Independent multivariate predictors for late MACE were restenotic lesion (relative risk [RR] 1.33, p = 0.02), PVD (RR: 1.31, p = 0.01), CHF (RR: 1.42, p = 0.01) and multiple stents (RR: 1.47, p = 0.004). Angiographic follow-up was available for 422 patients. Angiographic restenosis occurred in 122 (29%) of stented SVGs and 181 (43%) of nonstented SVGs (p = 0.04). Stent implantation did not confer a survival benefit. CONCLUSIONS: Despite the use of new interventional devices, SVG interventions are associated with significant morbidity and mortality; SVG stenting is not associated with better three-year event-free survival. This may be due to progressive disease at nonstented sites.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Artery Bypass/methods , Graft Occlusion, Vascular/therapy , Postoperative Complications/therapy , Saphenous Vein/transplantation , Stents , Aged , Atherectomy, Coronary , Disease Progression , Disease-Free Survival , Female , Graft Occlusion, Vascular/mortality , Humans , Male , Middle Aged , Recurrence , Retrospective StudiesABSTRACT
A 35-year-old man had significant left main coronary artery disease and required intra-aortic balloon catheter insertion owing to refractory ischemia before emergency coronary artery bypass graft. In the immediate postoperative period the patient started complaining of leg pain and diminished sensation in the right foot despite palpable pulses. The diagnosis of acute compartment syndrome of the right leg was made by an intracompartment pressure measurement of 90 mm Hg.
