Calidad de la medición antropométrica en las Unidades de Medicina Intensiva españolas (Estudio CAMIES) / Quality of anthropometric measurements in Spanish Intensive Care Units (The CAMIES Study)

INTRODUCCIÓN: El peso y la talla reales son datos de inexcusable obtención en todos los pacientes críticamente enfermos (PCE) por su implicación en el diseño de las terapias y la monitorización. La estimación visual es una práctica poco fiable. No existe una descripción precisa en las guías de práctica clínica del PCE acerca de la obtención de medidas antropométricas. OBJETIVO: Describir la calidad en la práctica de la antropometría en el PCE, la percepción de los sanitarios y los factores influyentes. DISEÑO: Entrevista telefónica y personal asistida por ordenador. Ámbito: Médicos y diplomados en Enfermería de todos los servicios de Medicina Intensiva (UCI) de adultos del territorio español. Variables de interés: Se exploró la práctica habitual de toma de medidas, la proclividad al uso de medidas reales y la influencia de la experiencia, el tamaño de la UCI y el grupo profesional. RESULTADOS: Se obtuvieron 481 cuestionarios desde 176 hospitales, el 36,8% de médicos. La dotación en equipos de medida es escasa (peso 68,7%, talla 76,7%) y no se relaciona con el tamaño de la UCI (peso p = 0,343, talla p = 0,61). La estimación visual es la forma más frecuente de obtener medidas (peso 65,9%, talla 64,8%), incluso cuando se dispone de herramientas de medida. La disposición a la toma de medidas reales es baja, sobre todo entre médicos (36,2% de rechazo) y mayor experiencia asoció mayor rechazo (p < 0,001). CONCLUSIONES: La estimación supera a la toma de medidas reales en la rutina de las UCI españolas. Las herramientas de medida no están ampliamente disponibles en las UCI y su uso es minoritario aun existiendo. La población encuestada es poco tendente a considerar importante la toma de medidas. Debe realizarse un esfuerzo por parte de las sociedades científicas para promover la práctica antropométrica fiable en las UCI españolas

INTRODUCTION: Real body weight and height are essential data to be obtained in all critically ill patients (CIP), due to their influence in the designing of therapies and monitoring. Visual estimation is a very inaccurate practice. No precise descriptions of anthropometric measurements among CIP are available in the clinical practice guides. OBJECTIVE: To describe anthropometric quality in CIP, health professional perception of such quality, and its influencing factors. DESIGN: Computer-assisted telephone or self-interviewing. SETTING: Doctors and nurses of all Spanish Intensive Care Units (ICU) attending adults. Relevant variables: Anthropometric practices were described in detail, along with the proclivity to obtain real measurements, and the influence of professional experience, the number of ICU beds, and the health professional group involved. RESULTS: A total of 481 questionnaires were collected from 176 hospitals (36.8% from physicians). The availability of measuring tools is limited (weight 68.7% - height 76.7%), with no relation to the number of ICU beds (weight P=.343, height P=.61). Visual estimation was the most frequent way of obtaining measurements (weight 65.9% - height 64.8%), even when measuring tools were available. Willingness to take real measurements was very low, especially among physicians, and professional experience was associated to increased rejection (P<.001). CONCLUSIONS: Visually estimated measurements exceed real measurements in the routine practice of Spanish ICUs. Measurement tools are not widely available in the ICU, and even when available, their use is not guaranteed. The surveyed population does not view anthropometric measures as being important for clinical practice. An effort should be made by scientific societies to promote reliable anthropometric practice in Spanish ICUs

Quality of anthropometric measurements in Spanish Intensive Care Units (The CAMIES Study). / Calidad de la medición antropométrica en las Unidades de Medicina Intensiva españolas (Estudio CAMIES).

INTRODUCTION: Real body weight and height are essential data to be obtained in all critically ill patients (CIP), due to their influence in the designing of therapies and monitoring. Visual estimation is a very inaccurate practice. No precise descriptions of anthropometric measurements among CIP are available in the clinical practice guides. OBJECTIVE: To describe anthropometric quality in CIP, health professional perception of such quality, and its influencing factors. DESIGN: Computer-assisted telephone or self-interviewing. SETTING: Doctors and nurses of all Spanish Intensive Care Units (ICU) attending adults. RELEVANT VARIABLES: Anthropometric practices were described in detail, along with the proclivity to obtain real measurements, and the influence of professional experience, the number of ICU beds, and the health professional group involved. RESULTS: A total of 481 questionnaires were collected from 176 hospitals (36.8% from physicians). The availability of measuring tools is limited (weight 68.7% - height 76.7%), with no relation to the number of ICU beds (weight P=.343, height P=.61). Visual estimation was the most frequent way of obtaining measurements (weight 65.9% - height 64.8%), even when measuring tools were available. Willingness to take real measurements was very low, especially among physicians, and professional experience was associated to increased rejection (P<.001). CONCLUSIONS: Visually estimated measurements exceed real measurements in the routine practice of Spanish ICUs. Measurement tools are not widely available in the ICU, and even when available, their use is not guaranteed. The surveyed population does not view anthropometric measures as being important for clinical practice. An effort should be made by scientific societies to promote reliable anthropometric practice in Spanish ICUs.

Relación entre el índice de masa corporal y el desarrollo de úlcera por presión en Medicina Intensiva / Correlation between body mass index and development of pressure ulcers in intensive care medicine

Objetivos: Evaluar la asociación entre índice de masa corporal (IMC) y aparición y severidad de la úlcera por presión (UPP) en pacientes que ingresan en Unidades de Medicina Intensiva (UMI). Describir el pronóstico diferencial de los pacientes con UPP y los factores que lo modifican. Material y métodos Estudio de casos y controles con observación durante 15 meses. Se recogieron variables de situación basal, escalas pronósticas, terapias y resultado clínico. Se realizó análisis univariante de cada variable entre casos y controles mediante el test de contraste de hipótesis adecuado en función de la naturaleza de las variables. Curva COR para determinar el IMC que marca la aparición de UPP. Análisis de regresión logística con UPP como variable dependiente y las covariables significativas a un nivel p < 0,05 en el análisis bivariante. Correlación mediante Pearson o Spearman entre IMC, albúmina, días hasta el diagnóstico de UPP, tiempo de inmovilización, y grado de UPP. El nivel de significación se definió para un valor de p < 0,05. Resultados: De 1.424 pacientes, 77 desarrollaron UPP. Los casos tuvieron mayor APACHE II (p = 0,043), SAPS 3 (p = 0,023), tiempo de estancia en UMI y de VM (p < 0,001) y complicaciones. El IMC ≥ 40 se asoció a UPP (p = 0,024 OR = 3,23 IC95% 1,17-8,93). Hubo asociación entre el grado de UPP y el tiempo de estancia y de VM (p < 0,001), pero no con los días de inmovilización, uso de colchón neumático y fallecimiento. El modelo multivariante encontró como factores pronósticos de UPP el tiempo de VM (p = 0,013, OR 1,08 IC95% 1,01-1,16) y la depuración extrarrenal (p = 0,013, OR 3,55 IC95% 1,31-9,64), siendo el IMC ≥ 40 un factor de confusión. Conclusiones: Los pacientes con IMC ≥ 40 desarrollaron más UPP, pero el IMC es un factor de confusión al asociar mayor tiempo de VM y depuración extrarrenal

Objectives: This study aims to evaluate the association between body mass index (BMI), incidence and severity of pressure ulcers (PU) in patients admitted to the Intensive Care Unit (ICU), and describe the differential prognosis of patients with PU and factors that modify it. Material and methods: Case-control study with observation period of 15 months. We collected baseline variables, prognostic scales, therapies and clinical outcome. Univariate analysis was performed for each outcome variable between cases and controls using the appropriate hypothesis test depending on the nature of the variables. ROC curve for BMI and PU. Logistic regression with PU as dependent variable and the covariates that reached p < 0.05 in the bivariate analysis. Correlation using Pearson or Spearman was made between BMI, albumin, days to diagnosis of UPP, immobilization, and PU degree. Significance level at p < 0.05. Results: 77 patients developed PU and 231 controls were chosen. The cases had higher APACHE II (p = 0.043) and SAPS 3 (p = 0.023), length of stay in ICU and mechanical ventilation (p< 0.001). BMI ≥ 40 was associated with UPP (p = 0.024 OR = 3.23 CI95% 1.17-8.93). There was a significant association between PU degree, length of stay and MV (p < 0,001), but not with immobilization, dynamic support surface and death rate. Multivariate analysis found association between PU, length of MV (p = 0.013, OR 1.08, CI95% 1.01-1.16) and kidney replacement therapy (p = 0.013, OR 3.55 CI95% 1.31-9.64), with BMI ≥ 40 as a confounding factor. Conclusions: Length of mechanical ventilation and renal replacement therapy are risk factors for pressure ulcer development, and BMI ≥ 40 acts as a confounding factor. PU development and its maximum degree are not associated with a worse prognosis

[Correlation between body mass index and development of pressure ulcers in intensive care medicine]. / Relación entre el índice de masa corporal y el desarrollo de úlcera por presión en Medicina Intensiva.

OBJECTIVES: This study aims to evaluate the association between body mass index (BMI), incidence and severity of pressure ulcers (PU) in patients admitted to the Intensive Care Unit (ICU), and describe the differential prognosis of patients with PU and factors that modify it. MATERIAL AND METHODS: Case-control study with observation period of 15 months. We collected baseline variables, prognostic scales, therapies and clinical outcome. Univariate analysis was performed for each outcome variable between cases and controls using the appropriate hypothesis test depending on the nature of the variables. ROC curve for BMI and PU. Logistic regression with PU as dependent variable and the covariates that reached p<0.05 in the bivariate analysis. Correlation using Pearson or Spearman was made between BMI, albumin, days to diagnosis of UPP, immobilization, and PU degree. Significance level at p <0.05. RESULTS: 77 patients developed PU and 231 controls were chosen. The cases had higher APACHE II (p=0.043) and SAPS 3 (p=0.023), length of stay in ICU and mechanical ventilation (p<0.001). BMI≥40 was associated with UPP (p=0.024 OR=3.23 CI95% 1.17-8.93). There was a significant association between PU degree, length of stay and MV (p<0,001), but not with immobilization, dynamic support surface and death rate. Multivariate analysis found association between PU, length of MV (p=0.013, OR 1.08, CI95% 1.01-1.16) and kidney replacement therapy (p=0.013, OR 3.55 CI95% 1.31-9.64), with BMI≥40 as a confounding factor. CONCLUSIONS: Length of mechanical ventilation and renal replacement therapy are risk factors for pressure ulcer development, and BMI≥40 acts as a confounding factor. PU development and its maximum degree are not associated with a worse prognosis.

[Medical and socio-economic effects of early rehabilitation of patients with acute cerebral vascular accidents].

Acute ischemic brain injury (stroke, stroke), a leader among the causes of morbidity and mortality in the world. This pathology is one of the most pressing health and social problems that cause enormous economic damage to society, due to the high fatality rate, significant disability and social maladjustment of patients, which is based in most cases are the motor and cognitive impairment. Despite the fact that, currently established risk factors and pathophysiological basis of this disease, the availability of effective methods of diagnosing illness, still a practicing neurologist in some cases difficult to find adequate therapy that could effectively reach a well-established neurological deficit. Therefore the search for treatments that effectively reduce the health and social consequences of vascular damage to the brain, is one of the priority areas of neurology.

[Optimization of medical-diagnostic process in patients with traumatic brain injury during early rehabilitation].

The problem of cardiovascular disease and cancer, the effects of traumatic brain injury is now one of the major health and social problems. Every year in Ukraine registered 200 thousand cases of the victims of traumatic brain injury. Of these, 30% of people then have persistent signs of disability that results in a disability, sometimes painful existence the patient and his relatives. Therefore, in order to bring man back into society after a traumatic brain injury, to the rehabilitation phase of treatment, immediately after the stabilization of the patient.

[Treatment and outcome of chronic hepatitis B in children]. / Techenie i iskhody khronicheskogo gepatitia B u detei.

225 children at the age from 6 months to 15 years with chronic hepatitis type B (CHB) were under observation. In addition to clinical biochemical evaluation and morphological recording, there also was the serologic monitoring of the pathologic process condition by means of determination of hepatitis type B and other hepatitis viruses markers. The patients were observed during 1-10 years. It was found that almost all of the patients, with the exception of 3 children (1.3%), had no acute onset of the disease. According to the morphological study data, changes in the liver varied from minimal to apparent activity, up to the formation of hepatocirrhosis in single cases. The clinical presentation of CHB in children included mainly the enlargement and induration of the liver, enlargement of the spleen and anhepatic signs (capillaritis and telangiectasia). After 4 years from the onset of CHB stable and prolonged remission was formed in most of the patients (64.6%); in 35.4% of cases clinical biochemical activity of the disease remained for a longer period of time (5-10 years or longer). The gradual cessation of the disease activity correlates with seroconversion of HBeAg on anti-Hbe. Children with the continuous pathologic process in the liver have HBV DNA in their blood. The main outcome of CHB in children is a prolonged remission with permanent HBs-antigenemia in 89% of cases. The recovery was recorded in 9.68% of cases (disappearance of HbsAg and acquisition of anti-HBs). Hepatocirrhosis was formed in 3 children (1.32%).

Use of recombinant alpha-2b-interferon in combination with antioxidants in the form of rectal suppositories (viferon) in children with chronic hepatitides B and C.

A new antiviral and immunomodulating preparation Viferon, produced as rectal suppositories containing recombinant alpha-2b-interferon (IFN) and antioxidants, was used in complex therapy of viral chronic hepatitides B and C (ChHB and ChHC) in children. Results of our investigation showed a high efficiency of Viferon. Viferon was found to suppress replication of hepatotropic viruses and to decrease activity of the pathologic process in the liver of children with ChHB and ChHC. After a Viferon treatment with daily doses of (1-2) x 10(6) IU of IFN (3.0 x 10(6) IU/m2) primary remission was registered in 78% of patients with ChHB and in 44% of patients with ChHC, while lasting remission was found in 82% of ChHB and in 33% of ChHC patients. Thus, a more marked effect was observed with ChHB, in which 3.0 x 10(6) IU/m2 was the optimal daily dose for children. Increasing the dose to 5.0 x 10(6) IU/m2 did not result in rise of the percentage of the remissions. Side effects, which are characteristic for injection of IFN preparations, were never found even after a longterm treatment. Absence of induction of neutralizing antibodies was observed after administration of alpha-2b-IFN, an integral part of Viferon. In pediatrics, the method of rectal administration has advantages over parenteral delivery due to its convenience, non-traumatic character and possibility of use for prolonged periods.

[The clinico-pathogenetic importance of evaluating monocyte phagocytic activity in viral hepatitis in children]. / Kliniko-patogeneticheskoe znachenie otsenki fagotsitarnoi aktivnosti monotsitov pri virusnykh gepatitakh u detei.

The phagocytic activity of blood monocytes in healthy donors and in children having virus hepatitis was studied. The cytological analysis of preparations made it possible to identify several variants of phagocytosis. Monocytes in children having the moderate form of acute virus hepatitis at the primary stage of the disease proved to be most active. The phagocytic activity of monocytes was low in chronic virus hepatitis. The treatment of children having acute virus hepatitis B with recombinant alfa-2 interferon restored the capacity of monocytes to phagocytose zymosan, which preceded the clinical manifestations of remission.

[Chronic hepatitis C in children]. / Khronicheskii gepatiti C u detei.

The clinico-laboratory manifestations and outcomes of chronic hepatitis C have been studied in 49 children. The proportion of chronic hepatitis C in the structure of chronic viral hepatitides in children is 20.5%. Among chronic hepatitis C patients, in 18.4% chronic persisting hepatitis, in 20.4% chronic active hepatitis and in 61.4% chronic active hepatitis with transition to cirrhosis of the liver have been diagnosed. In patients with chronic hepatitis C manifested as chronic persisting hepatitis or chronic active hepatitis the course of the disease is characterized by intermittent periods of prolonged exacerbations and short remissions. In cases of chronic active hepatitis with cirrhosis of the liver the signs of the active process can be constantly detected in the course of prolonged observations. In some patients with chronic active hepatitis the lethal outcome is possible as the consequence of progressing liver insufficiency. The data obtained in this investigation indicate that autoimmune chronic hepatitis in children, extensively described in Russian and foreign literature, may be etiologically linked with hepatitis C virus.

[The pathogenetic significance of disorders in macrophage function in viral hepatitis B and delta in children]. / Patogeneticheskoe znachenie narushenii funktsional'nogo sostoianiia makrofagov pri virusnykh gepatitakh B i del'ta u detei.

Overall 180 children aged 3 months to 12 years with acute and chronic hepatitis B and delta were examined for macrophagal function. Chemotaxis, saturation with esterase, the content of nuclear RNA were estimated, antigens of HB virus in these cells were identified as well. The data obtained attest to the correlation between the degree of macrophagal function disorders and the gravity of acute virus hepatitis. The chronic disease is characterized by stable depression of mononuclear cells with a tendency toward deeper depression of their function in patients with virus hepatitis delta as well as a higher rate of HBsAg and HBeAg demonstration in these cells. The authors provide evidence for advisability of the use of BCG vaccine and tactivin in patients with the chronic disease, since they improve macrophagal function, promote the inhibition of HB-virus replication and the onset of a stable remission in patients with chronic hepatitis B and delta.

[The detection of hepatitis B virus DNA in the blood serum of children with chronic HBsAg-positive hepatitis]. / Vyiavlenie DNK virusa gepatita B v syvorotke krovi u detei s khronicheskim HBsAg-pozitivnym gepatitom.

The presence of HBV DNA in the blood serum of 50 children with HBsAg-positive chronic hepatitis (36 with chronic hepatitis B, 14 with chronic hepatitis delta) was determined by molecular hybridization method. No significant differences were observed between the frequency of HBV DNA detection and clinicomorphological type of chronic HBsAg-positive hepatitis. In chronic HBV infection, HBV DNA was shown to be detected more frequently than in chronic hepatitis delta. A correlation was confirmed between the frequency of HBV DNA detection and demonstration of HBeAg in the blood. With the increase in the duration of the disease and age of the patients the HBV DNA detection rate was found to diminish.