Interaction of DisBa01 peptide from Bothrops alternatus venom with BRAF melanoma receptors: Modeling and molecular docking.

Metastatic melanoma is highly aggressive and challenging, often leading to a grim prognosis. Its progression is swift, especially when mutations like BRAFV600E continuously activate pathways vital for cell growth and survival. Although several treatments target this mutation, resistance typically emerges over time. In recent decades, research has underscored the potential of snake venoms and peptides as bioactive substances for innovative drugs, including anti-coagulants, anti-microbial, and anti-cancer agents. Leveraging this knowledge, we propose employing a bioinformatics simulation approach to: a) Predict how well a peptide (DisBa01) from Bothrops alternatus snake venom binds to the melanoma receptor BRAFV600E via Molecular Docking. b) Identify the specific peptide binding sites on receptors and analyze their proximity to active receptor sites. c) Evaluate the behavior of resulting complexes through molecular dynamics simulations. d) Assess whether this peptide qualifies as a candidate for anti-melanoma therapy. Our findings reveal that DisBa01 enhances stability in the BRAFV600E melanoma receptor structure by binding to its RGD motif, an interaction absent in the BRAF WT model. Consequently, both docking and molecular dynamics simulations suggest that DisBa01 shows promise as a BRAFV600E inhibitor.

An Approach for Engineering Peptides for Competitive Inhibition of the SARS-COV-2 Spike Protein.

SARS-CoV-2 is the virus responsible for a respiratory disease called COVID-19 that devastated global public health. Since 2020, there has been an intense effort by the scientific community to develop safe and effective prophylactic and therapeutic agents against this disease. In this context, peptides have emerged as an alternative for inhibiting the causative agent. However, designing peptides that bind efficiently is still an open challenge. Here, we show an algorithm for peptide engineering. Our strategy consists of starting with a peptide whose structure is similar to the interaction region of the human ACE2 protein with the SPIKE protein, which is important for SARS-COV-2 infection. Our methodology is based on a genetic algorithm performing systematic steps of random mutation, protein-peptide docking (using the PyRosetta library) and selecting the best-optimized peptides based on the contacts made at the peptide-protein interface. We performed three case studies to evaluate the tool parameters and compared our results with proposals presented in the literature. Additionally, we performed molecular dynamics (MD) simulations (three systems, 200 ns each) to probe whether our suggested peptides could interact with the spike protein. Our results suggest that our methodology could be a good strategy for designing peptides.

Elucidating the molecular mechanisms of essential oils' insecticidal action using a novel cheminformatics protocol.

Essential oils (EOs) are a promising source for novel environmentally safe insecticides. However, the structural diversity of their compounds poses challenges to accurately elucidate their biological mechanisms of action. We present a new chemoinformatics methodology aimed at predicting the impact of essential oil (EO) compounds on the molecular targets of commercial insecticides. Our approach merges virtual screening, chemoinformatics, and machine learning to identify custom signatures and reference molecule clusters. By assigning a molecule to a cluster, we can determine its most likely interaction targets. Our findings reveal that the main targets of EOs are juvenile hormone-specific proteins (JHBP and MET) and octopamine receptor agonists (OctpRago). Three of the twenty clusters show strong similarities to the juvenile hormone, steroids, and biogenic amines. For instance, the methodology successfully identified E-Nerolidol, for which literature points indications of disrupting insect metamorphosis and neurochemistry, as a potential insecticide in these pathways. We validated the predictions through experimental bioassays, observing symptoms in blowflies that were consistent with the computational results. This new approach sheds a higher light on the ways of action of EO compounds in nature and biotechnology. It also opens new possibilities for understanding how molecules can interfere with biological systems and has broad implications for areas such as drug design.

Ascending Flaccid Paralysis Secondary to Hypokalemia in A Cancer Patient using Abiraterone - A Case Report.

BACKGROUND: Prostate cancer (PC) is the most common type of neoplasm in men and the fourth leading cause of mortality in Brazil. The prostate cancer refractory metastatic castration can be treated with abiraterone acetate (AA). CASE PRESENTATION: Its use has been associated with increased survival. However, there are also side effects associated with the use of this drug, such as severe electrolyte disturbances. CONCLUSION: The objective is to report the clinical case of a patient with castration-resistant metastatic prostate cancer who developed ascending flaccid paralysis secondary to severe hypokalemia, probably due to hyperaldosteronism secondary to the use of Abiraterone Acetate, despite the use of Prednisone.

Increased oyster aquaculture in the Sado Estuary (Portugal): How to ensure ecosystem sustainability?

Aquaculture is one of the fastest growing sectors in the world. However, this may come with a cost, as increasing aquatic production is likely to impose changes in the environment. To ensure ecosystem sustainability, it is essential to think on this larger scale. This study aims to use the Delft3D model suite to evaluate the ecological carrying capacity for bivalve production in the Sado Estuary (Portugal), under present and future conditions (2050). Scenarios for increased oyster production resulted in reductions of chlorophyll a associated with increased nutrient concentrations. In the most extreme production scenario, which considered an increase of 100 ha in production area, a predicted decrease of 90 % in phytoplankton biomass was observed. Climate change (CC) was incorporated as an increase in sea level and water temperature, as well as a reduction in river flow. Under present oyster production conditions, CC revealed contrasting patterns, i.e. an increase in chlorophyll a concentrations and a reduction in nutrients. These results suggest that CC has a positive effect in counteracting the impacts of increased oyster production, however further research is necessary. All scenarios point to reduced dissolved oxygen concentrations, highlighting the need to monitor this parameter. Given the difficulty in defining what are unacceptable impacts to the ecosystem it would be prudent to include a socio-ecological framework in the future, in order to integrate ecosystem services and the perception of local stakeholders.

Características dos atendimentos às vítimas de trauma admitidas em um pronto socorro via transporte aéreo / Características de la atención a víctimas de traumas admitidos en el servicio de urgencias vía transporte aéreo / Characteristics of assistance to trauma victims admitted to an emergency room via air medical transport

Objetivo: Descrever as características dos atendimentos às vítimas de trauma admitidas em um pronto socorro de grande porte, via transporte aéreo. Método: Estudo transversal que analisou 107 prontuários de vítimas de trauma admitidas via transporte aéreo. Os dados foram submetidos à análise estatística descritiva. Resultados: Predominou o sexo masculino (63,3%), mediana de idade de 32 anos (IQ:23-51), vítimas de colisão automobilística (28,0%), transportadas por serviço aéreo público (86,0%) e nível de prioridade vermelho (55,7%). À admissão, 55,0% possuíam prótese de vias aéreas e 57,9% tiveram lesão na região do crânio. 72,9% realizou tomografia, 60,7% recebeu tratamento cirúrgico e 12,1% evoluiu a óbito no pronto socorro. O tempo de internação hospitalar teve mediana de sete dias (IQ: 1,5 -33,0), 57,0% recebeu alta domiciliar e 26,2% evoluiu a óbito. Conclusão: As vítimas, maioritariamente, eram graves e demandaram atendimento imediato e especializado, incluindo propedêuticas e terapêuticas de alta complexidade(AU)

Objective: To describe the characteristics of care provided to trauma victims admitted to an emergency room (ER) by air medical transport. Method: 107 medical records were collected and submitted to descriptive statistical analysis. Results: Prevalence of male individuals (63.3%), at a median age of 32 years (IQR: 23-51), car crash as a trauma mechanism (28.0%), public air transport (86.0%), and emergency priority level (55.7%). Upon admission, 55.0% had airway prosthesis, 68.2% received supplemental oxygen and 85.0% were immobilized on a long backboard. Limbs (66.3%) and skull (57.9%) were the most affected body regions. Tomography was performed in 72.9%. 60.7% received surgical treatment while 12.1% died in the ER. Length of hospital stay was seven days (IQR: 1.5 -33.0). More than half were discharged (57.0%) and 26.2% died. Conclusion: Trauma victims admitted via air medical transport were mostly in serious condition and demanded immediate, specialized care, including highly complex care(AU)

Objetivo: Describir las características de la atención a las víctimas de trauma admitidas en un servicio de urgencias vía transporte aéreo. Método: Este estudio transversal analizó 107 historias clínicas de pacientes víctimas de trauma, admitidos en un servicio de urgencias vía transporte aéreo. Resultados: Predominó el sexo masculino (63,3%), edad mediana de 32 años (IQ:23-51), colisión automovilística como mecanismo de lesión (28,0%), transporte por servicio aéreo público (86,0%) y nivel de prioridad emergencia (55,7%). En la admisión, 55,0% tenían prótesis de vía aérea, 68,2% recibian oxígeno suplementario y 85,0% estaban inmovilizados en tablas largas. Los miembros (66,3%) y cráneo (57,9%) fueron lasregiones corporales más afectadas. La tomografía fue realizada en 72,9%, 60,7% recibió tratamiento quirúrgico y 12,1% evolucionaron a óbito. El tiempo de internación fue de siete días (IQ: 1,5-33,0). 57,0% recibió alta domiciliaria y 26,2% evolucionaron a óbito. Conclusiones: Las víctimas de trauma admitidas vía transporte aéreo eran en su mayoría graves y demandaron atención inmediata y especializada, incluyendo propedéuticas y terapéuticas de alta complejidad(AU)

Highly active antiretroviral therapy for critically ill HIV patients: A systematic review and meta-analysis.

INTRODUCTION: It is unclear whether the treatment of an HIV infection with highly active antiretroviral therapy (HAART) affects intensive care unit (ICU) outcomes. In this paper, we report the results of a systematic review and meta-analysis performed to summarize the effects of HAART on the prognosis of critically ill HIV positive patients. MATERIALS AND METHODS: A bibliographic search was performed in 3 databases (PubMed, Web of Science and Scopus) to identify articles that investigated the use of HAART during ICU admissions for short- and long-term mortality or survival. Eligible articles were selected in a staged process and were independently assessed by two investigators. The methodological quality of the selected articles was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. RESULTS: Twelve articles met the systematic review inclusion criteria and examined short-term mortality. Six of them also examined long-term mortality (≥90 days) after ICU discharge. The short-term mortality meta-analysis showed a significant beneficial effect of initiating or maintaining HAART during the ICU stay (random effects odds ratio 0.53, p = 0.02). The data analysis of long-term outcomes also suggested a reduced mortality when HAART was used, but the effect of HAART on long-term mortality of HIV positive critically ill patients remains uncertain. CONCLUSIONS: This meta-analysis suggests improved survival rates for HIV positive patients who were treated with HAART during their ICU admission.

Revisão sistemática de fatores prognósticos a curto prazo de pacientes HIV internados em uma unidade de cuidados intensivos / Systematic review of short-term prognostic factors of HIV patients admitted to an intensive care unit

Conhecer os fatores prognósticos de curto prazo de pacientes HIV, criticamente doentes, na era de terapia antirretroviral combinada, é importante para adoção de medidas preventivas e mais efetivas de tratamento. Para identificar os fatores mais significativos e comuns que determinam a mortalidade a curto prazo, uma revisão sistemática da literatura mais relevante foi conduzida. Método: Uma busca na internet foi conduzida em 3 bases de dados de artigos científicos indexados (PubMed, Scopus e Web of Science) para estudos que investigaram fatores prognósticos de mortalidade ou sobrevivência a curto prazo (em UTIs, ou em outros setores do hospital, seguindo a internação na UTI) de pacientes HIV criticamente enfermos. Os artigos foram selecionados de acordo com critérios pré-estabelecidos e avaliados independentemente por 2 pesquisadores. As variáveis coletadas foram autor, ano, local e tipo do estudo, número de pacientes com HIV, mortalidade, fatores significativos em regressão logística simples e múltipla, principais causas de admissão e critérios de inclusão. Resultados: Vinte e seis artigos foram selecionados para revisão sistemática. Quinze lidaram com fatores que determinavam mortalidade na UTI, 9 com mortalidade hospitalar após internação em UTI, e 2 com ambos. Conclusões: Fatores associados à gravidade de doença aguda, como escores prognósticos, albumina e disfunção orgânica (choque e insuficiência respiratória) parecem ser mais importantes como determinantes da mortalidade a curto prazo que aqueles associados ao HIV.

Knowing the short-term prognostic factors of critically ill HIV patients admitted to intensive care units (ICUs) in the era of combination antiretroviral therapy (cART) is important for the adoption of preventive measures and more effective treatment. To identify the most significant and common factors that determine short-term mortality, a systematic review of the relevant literature was carried out. Method: An internet search was conducted in three databases indexing scientific articles (PubMed, Scopus, and Web of Science) for studies investigating the prognostic factors of mortality or short-term survival (in ICUs and elsewhere in hospitals following ICU admission) of critically ill HIV-infected patients. The articles were selected according to pre-established criteria and evaluated independently by two researchers. The variables collected were author, year, study location, study type, number of patients with HIV, mortality, significant factors in simple logistic regression and multiple regression, main causes of admission, and inclusion criteria. Results: Twenty-six articles were selected for systematic review. Fifteen dealt with factors that determine mortality in the ICU, nine with hospital mortality following ICU admission, and two with both. Conclusions: Factors associated with the severity of acute disease, such as prognostic scores, albumin, and organ failure (shock and respiratory failure), seem to be more important as determinants of short-term mortality than those associated with HIV

Diretrizes para avaliação e validação do potencial doador de órgãos em morte encefálica / Guidelines for the assessment and acceptance of potential brain-dead organ donors

RESUMO O transplante de órgãos é a única alternativa para muitos pacientes portadores de algumas doenças terminais. Ao mesmo tempo, é preocupante a crescente desproporção entre a alta demanda por transplantes de órgãos e o baixo índice de transplantes efetivados. Dentre as diferentes causas que alimentam essa desproporção, estão os equívocos na identificação do potencial doador de órgãos e as contraindicações mal atribuídas pela equipe assistente. Assim, o presente documento pretende fornecer subsídios à equipe multiprofissional da terapia intensiva para o reconhecimento, a avaliação e a validação do potencial doador de órgãos.

ABSTRACT Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.

Defining and treating acute kidney injury patients in Brazilian intensive care units: Results from a cross-sectional nationwide survey.

PURPOSE: The purpose of the study is to characterize the practices of Brazilian intensivists toward acute kidney injury (AKI) definition and management. METHODS: A cross-sectional survey was conducted among 36 Brazilian hospitals. RESULTS: Of 731 ICU physicians invited to participate, 310 (42%) responded to the survey. Nearly half of the intensive care unit (ICU) physicians (146/310) do not apply AKIN and/or RIFLE definitions to their ICU patients. Most of the respondents prescribe intravenous fluids as a first-line therapeutic intervention for AKI patients. Although 38% of the surveyed physicians considered worsening of respiratory parameters to be the main criterion for stopping fluid infusion, only 15% considered daily net fluid balance as a criterion. Most of the respondents believed in the benefits of early renal replacement therapy (RRT) and considered worsening acidosis the most important criteria for starting early RRT. The main reason for a nephrologist referral was an urgently needed RRT. CONCLUSIONS: Despite recent advances in AKI definition and management, most of the surveyed ICU physicians in Brazil have not incorporated them in their clinical practice. Important differences in the management of AKI patients were observed among Brazilian ICU physicians, which is relevant for educational interventions and future research.

Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study.

BACKGROUND: To characterize and identify prognostic factors for 28-day mortality among patients with hospital-acquired fungemia (HAF) in the Intensive Care Unit (ICU). METHODS: A sub-analysis of a prospective, multicenter non-representative cohort study conducted in 162 ICUs in 24 countries. RESULTS: Of the 1156 patients with hospital-acquired bloodstream infections (HA-BSI) included in the EUROBACT study, 96 patients had a HAF. Median time to its diagnosis was 20 days (IQR 10.5-30.5) and 9 days (IQR 3-15.5) after hospital and ICU admission, respectively. Median time to positivity of blood culture was longer in fungemia than in bacteremia (48.7 h vs. 38.1 h; p = 0.0004). Candida albicans was the most frequent fungus isolated (57.1%), followed by Candida glabrata (15.3%) and Candida parapsilosis (10.2%). No clear source of HAF was detected in 33.3% of the episodes and it was catheter-related in 21.9% of them. Compared to patients with bacteremia, HAF patients had a higher rate of septic shock (39.6% vs. 21.6%; p = 0.0003) and renal dysfunction (25% vs. 12.4%; p = 0.0023) on admission and a higher rate of renal failure (26% vs. 16.2%; p = 0.0273) at diagnosis. Adequate treatment started within 24 h after blood culture collection was less frequent in HAF patients (22.9% vs. 55.3%; p < 0.001). The 28-day all cause fatality was 40.6%. According to multivariate analysis, only liver failure (OR 14.35; 95% CI 1.17-175.6; p = 0.037), need for mechanical ventilation (OR 8.86; 95% CI 1.2-65.24; p = 0.032) and ICU admission for medical reason (OR 3.87; 95% CI 1.25-11.99; p = 0.020) were independent predictors of 28-day mortality in HAF patients. CONCLUSIONS: Fungi are an important cause of hospital-acquired BSI in the ICU. Patients with HAF present more frequently with septic shock and renal dysfunction on ICU admission and have a higher rate of renal failure at diagnosis. HAF are associated with a significant 28-day mortality rate (40%), but delayed adequate antifungal therapy was not an independent risk factor for death. Liver failure, need for mechanical ventilation and ICU admission for medical reason were the only independent predictors of 28-day mortality.

Sepsis-Associated Outcomes in Critically Ill Patients with Malignancies.

RATIONALE: Sepsis is a major cause of mortality among critically ill patients with cancer. Information about clinical outcomes and factors associated with increased risk of death in these patients is necessary to help physicians recognize those patients who are most likely to benefit from ICU therapy and identify possible targets for intervention. OBJECTIVES: In this study, we evaluated cancer patients with sepsis chosen from a multicenter prospective study to characterize their clinical characteristics and to identify independent risk factors associated with hospital mortality. METHODS: Subgroup analysis of a multicenter prospective cohort study conducted in 28 Brazilian intensive care units (ICUs) to evaluate adult cancer patients with severe sepsis and septic shock. We used logistic regression to identify variables associated with hospital mortality. MEASUREMENTS AND MAIN RESULTS: Of the 717 patients admitted to the participating ICUs, 268 (37%) had severe sepsis (n = 142, 53%) or septic shock (n = 126, 47%). These patients comprised the population of the present study. The mean score on the third version of the Simplified Acute Physiology Score was 62.9 ± 17.7 points, and the median Sequential Organ Failure Assessment score was 9 (7-12) points. The most frequent sites of infection were the lungs (48%), intraabdominal region (25%), bloodstream as primary infection (19%), and urinary tract (17%). Half of the patients had microbiologically proven infections, and Gram-negative bacteria were the most common pathogens causing sepsis (31%). ICU and hospital mortality rates were 42% and 56%, respectively. In multivariable analysis, the number of acute organ dysfunctions (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16-1.87), hematological malignancies (OR, 2.57; 95% CI, 1.05-6.27), performance status 2-4 (OR, 2.53; 95% CI, 1.44-4.43), and polymicrobial infections (OR, 3.74; 95% CI, 1.52-9.21) were associated with hospital mortality. CONCLUSIONS: Sepsis is a common cause of critical illness in patients with cancer and remains associated with high mortality. Variables related to underlying malignancy, sepsis severity, and characteristics of infection are associated with a grim prognosis.

Clinical Profiles and Factors Associated with Death in Adults with Dengue Admitted to Intensive Care Units, Minas Gerais, Brazil.

The purpose of our study was to describe the clinical profile of dengue-infected patients admitted to Brazilian intensive care units (ICU) and evaluate factors associated with death. A longitudinal, multicenter case series study was conducted with laboratory-confirmed dengue patients admitted to nine Brazilian ICUs situated in Minas Gerais state, southeastern Brazil from January 1, 2008, to December 31, 2013. Demographic, clinical and laboratory data; disease severity scores; and mortality were evaluated. A total of 97 patients were studied. The in-ICU and in-hospital mortality rates were 18.6% and 19.6%, respectively. Patients classified as having severe dengue according to current World Health Organization classifications showed an increased risk of death in a univariate analysis. Nonsurvivors were older, exhibited lower serum albumin concentrations and higher total leukocyte counts and serum creatinine levels. Other risk factors (vomiting, lethargy/restlessness, dyspnea/respiratory distress) were also associated with death in a univariate analysis. Multivariate analysis indicated that in-hospital mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and the Sequential Organ Failure Assessment score. The ICU and in-hospital mortality observed in this study were higher than values reported in similar studies. An increased frequency of ICU admission due to severe organ dysfunction, higher severity indices and scarcity of ICU beds may partially explain the higher mortality.

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study.

INTRODUCTION: Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV). METHODS: A secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality. RESULTS: A total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P = 0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P = 0.001) despite similar PaO2/FiO2 ratios and acute respiratory distress syndrome (ARDS) severity. In a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% CI, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; CI 95%, 1.00 to 1.04), severe ARDS (OR 1.44; CI 95%, 1.09 to 1.91) and deep sedation (OR 2.36; CI 95%, 1.31 to 4.25) were independently associated with increased hospital mortality. CONCLUSIONS: Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.

Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study.

PURPOSE: The recent increase in drug-resistant micro-organisms complicates the management of hospital-acquired bloodstream infections (HA-BSIs). We investigated the epidemiology of HA-BSI and evaluated the impact of drug resistance on outcomes of critically ill patients, controlling for patient characteristics and infection management. METHODS: A prospective, multicentre non-representative cohort study was conducted in 162 intensive care units (ICUs) in 24 countries. RESULTS: We included 1,156 patients [mean ± standard deviation (SD) age, 59.5 ± 17.7 years; 65 % males; mean ± SD Simplified Acute Physiology Score (SAPS) II score, 50 ± 17] with HA-BSIs, of which 76 % were ICU-acquired. Median time to diagnosis was 14 [interquartile range (IQR), 7-26] days after hospital admission. Polymicrobial infections accounted for 12 % of cases. Among monomicrobial infections, 58.3 % were gram-negative, 32.8 % gram-positive, 7.8 % fungal and 1.2 % due to strict anaerobes. Overall, 629 (47.8 %) isolates were multidrug-resistant (MDR), including 270 (20.5 %) extensively resistant (XDR), and 5 (0.4 %) pan-drug-resistant (PDR). Micro-organism distribution and MDR occurrence varied significantly (p < 0.001) by country. The 28-day all-cause fatality rate was 36 %. In the multivariable model including micro-organism, patient and centre variables, independent predictors of 28-day mortality included MDR isolate [odds ratio (OR), 1.49; 95 % confidence interval (95 %CI), 1.07-2.06], uncontrolled infection source (OR, 5.86; 95 %CI, 2.5-13.9) and timing to adequate treatment (before day 6 since blood culture collection versus never, OR, 0.38; 95 %CI, 0.23-0.63; since day 6 versus never, OR, 0.20; 95 %CI, 0.08-0.47). CONCLUSIONS: MDR and XDR bacteria (especially gram-negative) are common in HA-BSIs in critically ill patients and are associated with increased 28-day mortality. Intensified efforts to prevent HA-BSIs and to optimize their management through adequate source control and antibiotic therapy are needed to improve outcomes.

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas / Guidelines for potential multiple organ donors (adult). Part III: organ-specific recommendations

A morte encefálica induz várias alterações fisiopatológicas que podem causar lesões em rins, pulmões, coração e fígado. Portanto, a atuação do intensivista durante a manutenção do potencial doador falecido exige cuidados específicos com estes órgãos visando sua maior viabilidade para transplantes. O manejo hemodinâmico cuidadoso, os cuidados ventilatórios e de higiene brônquica minimizam a perda de rins e pulmões para o transplante. A avaliação da condição morfológica e funcional do coração auxilia na avaliação do potencial transplantável deste órgão. Por fim, a avaliação da função hepática, assim como o controle metabólico e a realização de sorologias virais são fundamentais para a orientação das equipes transplantadoras na seleção do órgão a ser doado e no cuidado com o receptor.

Brain death (BD) alters the pathophysiology of patients and may damage the kidneys, the lungs, the heart and the liver. To obtain better quality transplant organs, intensive care physicians in charge of the maintenance of deceased donors should attentively monitor these organs. Careful hemodynamic, ventilatory and bronchial clearance management minimizes the loss of kidneys and lungs. The evaluation of cardiac function and morphology supports the transplant viability assessment of the heart. The monitoring of liver function, the management of the patient's metabolic status and the evaluation of viral serology are fundamental for organ selection by the transplant teams and for the care of the transplant recipient.

Guidelines for potential multiple organ donors (adult). Part III: organ-specific recommendations. / Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas.

Brain death (BD) alters the pathophysiology of patients and may damage the kidneys, the lungs, the heart and the liver. To obtain better quality transplant organs, intensive care physicians in charge of the maintenance of deceased donors should attentively monitor these organs. Careful hemodynamic, ventilatory and bronchial clearance management minimizes the loss of kidneys and lungs. The evaluation of cardiac function and morphology supports the transplant viability assessment of the heart. The monitoring of liver function, the management of the patient's metabolic status and the evaluation of viral serology are fundamental for organ selection by the transplant teams and for the care of the transplant recipient.

Ventilação mecânica não invasiva em pacientes com síndrome respiratória aguda grave, suspeitos de infecção por influenza A - H1N1: relato de casos / Non invasive mechanical ventilation in acute lung injury and swine-origin influenza A H1N1 suspicion: case report

Objetivo: Apresentar, através de relato de caso, a aplicação da ventilação mecânica não invasiva (VMNI) em pacientes com Síndrome Respiratória Aguda Grave (SRAG), suspeitos de H1N1, internados no Centro de Terapia Intensiva (CTI) do Hospital Eduardo de Menezes (HEM). Materiais e Métodos: Quatro mulheres com idades entre 16 e 50 anos, com SRAG, foram submetidas à VMNI em ventiladores micro processados utilizando a máscara full face, com parâmetros mínimos a fim de melhorar a taquidispnéia e a queda da saturação de oxigênio, conforme protocolo criado pela equipe do CTI do HEM. Resultado: após aplicação da VMNI houve melhora do padrão respiratório e da saturação, observados clinicamente e através de gasometria e RX, menor permanência no CTI (3-5 dias), e não houve necessidade de intubação orotraqueal, diminuindo complicações e custos da mesma. Conclusão: Embora a VMNI tenha sido evidenciada como uma pratica controversa para os pacientes sob investigação de H1N1, neste relato de caso mostrou-se eficaz quando aplicado criteriosamente e bem indicado.(AU)

Objectives: To present, in a series of case reports, the use of non invasive ventilation (NIV) in patients with acute lung injury (ALI) and swine-origin influenza A H1N1 suspicion, in Intensive Care Unit of Eduardo de Menezes Hospital (HEM). Materials and Methods: Four women, aged between 16 and 50, with ALI, underwent a protocol of NIV in micro processed ventilators, using full face mask and minimal parameters to obtain an improvement of tachidispnoea and drop of oxygen saturation; according to protocol created by UCI team. Results: There was an improvement of respiratory pattern and saturation, seen clinically and through arterial blood gas analyses and chest radiography; shorter stay in UCI (3-5 days), and there was no need of endotracheal intubation, decreasing complications and costs. Conclusion: Although NIV has been a controversial practice to patients under suspicion of swine-origin influenza, this case report showed efficacy when carefully applied and indicated.(AU)

Retorno ao singular e enunciação analisante / Return to the singular and analysand enunciation

Nesse texto, procura-se retomar o tema da "enunciação analisante" que inspira a XV Jornada da EBP-MG, remetendo seu recorte ao contexto mais amplo da política da AMP. Assim como a via do sonho implica necessariamente as associações do sonhador, a formação do analista remete sempre à posição analisante a partir da qual se singulariza e se res-significa todo o saber acumulado em sua experiência clínica.