Adverse events leading to intensive care unit admission in a low-and-middle-income-country: A prospective cohort study and a systematic review.

INTRODUCTION: Adverse events (AE) are frequent in critical care and could be even more prevalent in LMIC due to a shortage of ICU beds and Human resources. There is limited data on how relevant AE are among the reasons for ICU admission, being all of which published by High-Income-Countries services. Our main goal is to describe the rate of adverse events-related ICU admissions and their preventability in a LMIC scenario, comparing our results with previous data. METHODS: This was a prospective cohort study, during a one-year period, in two general ICUs from a tertiary public academic hospital. Our exposure of interest was ICU admission related to an AE in adult patients, we further characterized their preventability and clinical outcomes. We also performed a systematic review to identify and compare previous published data on ICU admissions due to AE. RESULTS: Among all ICU admissions, 12.1% were related to an AE (9.8% caused by an AE, 2.3% related but not directly caused by an AE). These ICU admissions were not associated with a higher risk of death, but most of them were potentially preventable (70.9% of preventability rate, representing 8.6% of all ICU admissions). The meta-analysis resulted in a proportion of ICU admissions due to AE of 11% (95% CI 6%-16%), with a preventability rate of 54% (95% CI 42%-66%). CONCLUSIONS: In this prospective cohort, adverse events were a relevant reason for ICU admission. This result is consistent with data retrieved from non-LMIC as shown in our meta-analysis. The high preventability rate described reinforces that quality and safety programs could work as a tool to optimize scarce resources.

Acanthosis Nigricans associated with clear-cell renal cell carcinoma.

Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia. The latter, also known as malignant AN, is mostly related to abdominal neoplasms. Malignant AN occurs frequently among elderly patients. In these cases, the onset is subtle, and spreading involves the flexural regions of the body, particularly the axillae, palms, soles, and mucosa. Gastric adenocarcinoma is the most frequent associated neoplasia, but many others have been reported. Renal cell carcinoma (RCC), although already reported, is rarely associated with malignant AN. The authors report the case of a woman who was being treated for depression but presented a long-standing and marked weight loss, followed by darkening of the neck and the axillary regions. Physical examination disclosed a tumoral mass in the left flank and symmetrical, pigmented, velvety, verrucous plaques on both axillae, which is classical for AN. The diagnostic work-up disclosed a huge renal mass, which was resected and further diagnosed as a RCC. The post-operative period was uneventful and the skin alteration was evanescent at the first follow-up consultation. The authors call attention to the association of AN with RCC.

Acanthosis Nigricans associated with clear-cell renal cell carcinoma

Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia. The latter, also known as malignant AN, is mostly related to abdominal neoplasms. Malignant AN occurs frequently among elderly patients. In these cases, the onset is subtle, and spreading involves the flexural regions of the body, particularly the axillae, palms, soles, and mucosa. Gastric adenocarcinoma is the most frequent associated neoplasia, but many others have been reported. Renal cell carcinoma (RCC), although already reported, is rarely associated with malignant AN. The authors report the case of a woman who was being treated for depression but presented a long-standing and marked weight loss, followed by darkening of the neck and the axillary regions. Physical examination disclosed a tumoral mass in the left flank and symmetrical, pigmented, velvety, verrucous plaques on both axillae, which is classical for AN. The diagnostic work-up disclosed a huge renal mass, which was resected and further diagnosed as a RCC. The post-operative period was uneventful and the skin alteration was evanescent at the first follow-up consultation. The authors call attention to the association of AN with RCC

Tuberculosis with malaria or HIV co-infection in a large hospital in Luanda, Angola.

INTRODUCTION: Three major public health problems, tuberculosis, malaria and HIV/AIDS, are widespread in Angola, often as co-infections in the same individual. In 2009, it was assumed that 44,151 new cases of TB occurred in Angola. Interestingly, interventions such as treatment/prevention of malaria appear to reduce mortality in HIV-infected and possibly TB co-infected patients. However, despite the seriousness of the situation, current data on TB and co-infection rates are scarce. This study aimed to characterize all TB cases seen at the Hospital Sanatório de Luanda, and to determine the co-infection rate with HIV and/or malaria. METHODOLOGY: This retrospective study collected demographic, diagnostic and clinical data from all patients admitted during 2007. RESULTS: A total of 4,666 patients were admitted, of whom 1,906 (40.8%) were diagnosed with TB. Overall, 1,111 patients (58.3%) were male and most patients (n=1302, 68.3%) were adults (≥ 14 years). The rate of HIV co-infection was 37.4% (n=712). Malaria was diagnosed during admission and hospital stay in 714 patients (37.5%), with Plasmodium falciparum the predominant species. Overall mortality was 15.2% (n=290). CONCLUSIONS: Because Luanda does not have the infrastructure to perform culture-based diagnosis of TB, confirmation of TB is problematic. The HIV-co-infection rate is high, with 37.4% of patients requiring integrated approaches to address this problem. With more than 1/3 of the TB patients co-infected with malaria, even during the hospital stay, the prevention of malaria in TB patients appears to be an effective way to reduce overall mortality.

Compressive strength evaluation of structural lightweight concrete by non-destructive ultrasonic pulse velocity method.

In this paper the compressive strength of a wide range of structural lightweight aggregate concrete mixes is evaluated by the non-destructive ultrasonic pulse velocity method. This study involves about 84 different compositions tested between 3 and 180 days for compressive strengths ranging from about 30 to 80 MPa. The influence of several factors on the relation between the ultrasonic pulse velocity and compressive strength is examined. These factors include the cement type and content, amount of water, type of admixture, initial wetting conditions, type and volume of aggregate and the partial replacement of normal weight coarse and fine aggregates by lightweight aggregates. It is found that lightweight and normal weight concretes are affected differently by mix design parameters. In addition, the prediction of the concrete's compressive strength by means of the non-destructive ultrasonic pulse velocity test is studied. Based on the dependence of the ultrasonic pulse velocity on the density and elasticity of concrete, a simplified expression is proposed to estimate the compressive strength, regardless the type of concrete and its composition. More than 200 results for different types of aggregates and concrete compositions were analyzed and high correlation coefficients were obtained.

Tuberculosis with Malaria or HIV Co-Infection in a Large Hospital in Luanda; Angola

"Introduction: Three major public health problems; tuberculosis; malaria and HIV/AIDS; are widespread in Angola; often as co-infections in the same individual. In 2009; it was assumed that 44;151 new cases of TB occurred in Angola. Interestingly; interventions such as treatment/prevention of malaria appear to reduce mortality in HIV-infected and possibly TB co-infected patients. However; despite the seriousness of the situation; current data on TB and co-infection rates are scarce. This study aimed to characterize all TB cases seen at the Hospital Sanatorio de Luanda; and to determine the co-infection rate with HIV and/or malaria. Methodology: This retrospective study collected demographic; diagnostic and clinical data from all patients admitted during 2007. Results: A total of 4;666 patients were admitted; of whom 1;906 (40.8) were diagnosed with TB. Overall; 1;111 patients (58.3) were male and most patients (n=1302; 68.3) were adults (""d14 years). The rate of HIV co-infection was 37.4 (n=712). Malaria was diagnosed during admission and hospital stay in 714 patients (37.5); with Plasmodium falciparum the predominant species. Overall mortality was 15.2(n=290). Conclusions: Because Luanda does not have the infrastructure to perform culture-based diagnosis of TB; confirmation of TB is problematic. The HIV-co-infection rate is high; with 37.4 of patients requiring integrated approaches to address this problem. With more than 1/3 of the TB patients co-infected with malaria; even during the hospital stay; the prevention of malaria in TB patients appears to be an effective way to reduce overall mortality."

Alterações clínicas e patológicas durante a infecção experimental com Eimeria acervulina em frangos de corte suplementados com betaína

Com o objetivo de se avaliar o efeito da betaína na patogenicidade de Eimeria acervulina, 420 pintos de corte Cobb foraminoculados experimentalmente com 2 x 105 oocistos esporulados e alocados em baterias num esquema de blocos ao acasocom cinco tratamentos e seis repetições, incluindo-se um controle positivo, um grupo tratado com o anticoccidiano salinomicinae promotor de crescimento, e mais três níveis de betaína como aditivo na ração a 0,05, 0,10 e 0,15%. No 14o dia de vida as avesforam individualmente infectadas com 2 x 105 oocistos esporulados. A betaína não foi capaz de interferir positivamente naresposta clínica e patologia das aves durante a infecção por E. acervulina, no entanto foi capaz de aumentar a produção deoocistos. É provável que a betaína possa ser utilizada como aditivo na ração das aves em substituição aos medicamentosconvencionais salinomicina e penicilina G potássica, cujos efeitos são semelhantes na recuperação do hospedeiro frente àcoccidiose.

Alterações clínicas e patológicas durantea infecção experimental com Eimeria acervulinaem frangos de corte suplementados com betaína / Clinical and pathological changes during the experimental infection with Eimeria acervulina in broiler chickens suplemented with betaine

Com o objetivo de se avaliar o efeito da betaína na patogenicidade de Eimeria acervulina, 420 pintos de corte Cobb foraminoculados experimentalmente com 2 x 105 oocistos esporulados e alocados em baterias num esquema de blocos ao acasocom cinco tratamentos e seis repetições, incluindo-se um controle positivo, um grupo tratado com o anticoccidiano salinomicinae promotor de crescimento, e mais três níveis de betaína como aditivo na ração a 0,05, 0,10 e 0,15 por cento. No 14o dia de vida as avesforam individualmente infectadas com 2 x 105 oocistos esporulados. A betaína não foi capaz de interferir positivamente naresposta clínica e patologia das aves durante a infecção por E. acervulina, no entanto foi capaz de aumentar a produção deoocistos. É provável que a betaína possa ser utilizada como aditivo na ração das aves em substituição aos medicamentosconvencionais salinomicina e penicilina G potássica, cujos efeitos são semelhantes na recuperação do hospedeiro frente àcoccidiose.

Purposing to investigate the betaine effect on biology and morphology of developmental stages of Eimeria acervulina, 420 Cobbbroiler chicks were experimentally inoculated with 2 x 105 sporulated oocysts and housed in battery cages in a block design withfive treatments and six replicates each, including a positive control, a group treated with the anticoccidial salinomycin plusantibiotic growth promoter plus three levels of betaine as additive in the feed 0.05, 0.10 and 0.15 percent. Betaine was not able to affectthe clinical response and pathology during the infection, but improved oocyst output, possibly due to the osmotic mechanisms.In fact betaine could replace salinomycin plus growth promoter as additive in the feed which effects is closer in the recovery ofthe host affected by coccidiosis.

Fixation in patients with juvenile macular disease.

PURPOSE: The instability of fixation with central scotoma has been mainly studied in patients with age-related macular diseases (MDs). However, early macular lesions can lead to different characteristics of fixation. The aim of this work was to study fixation in patients with juvenile MD. METHODS: Eye movements of 10 patients and 10 controls were monitored during fixation. Visual fields were assessed by static perimetry to determine the extent of the field defects. Eye movements were separated into saccades and drifts, with fixation stability assessed by bivariate contour ellipse area (BCEA). To quantify the number and location of preferred retinal loci (PRL), the kernel density estimator and expectation maximization for mixtures of gaussians were used. RESULTS: Patients have worse fixation stability than controls and large BCEAs resulted in more than one PRL. It was found that central field defects (10 degrees) have negative correlation with the size of BCEA. In addition, the meridian of saccades during fixation was correlated with the meridian inter-PRL. CONCLUSIONS: Patients with juvenile MDs have large BCEAs, frequently associated with two PRL. Similar results had been found for patients with age-related MDs. Also, the meridian of involuntary saccades during fixation was found to be correlated with the location of PRLs, suggesting a useful role of these movements in alternating between them.

Composição química e valores energéticos de fontes protéicas em codornas de corte em diferentes idades / Chemical composition and energetic values of proteic sources in meat quails at different ages

Avaliou-se a composição química de quatro alimentos protéicos, bem como o efeito da idade de codornas para corte sobre os valores de energia metabolizável aparente (EMA) e aparente corrigida pelo balanço de nitrogênio (EMAn). Os alimentos testados foram farinha de vísceras de aves, farinha de penas, farinha de penas e vísceras e farelo de soja, os quais substituíram 30 por cento da dieta referência. Foi utilizado o método de colheita total de excretas, com 250 codornas, machos, em dois diferentes períodos de crescimento (20 a 25 e 35 a 40 dias de idade). O delineamento experimental utilizado foi o inteiramente casualizado, em esquema fatorial 4 x 2 (4 alimentos x 2 períodos) com cinco repetições por tratamento, de dez aves cada. Ocorreram variações quanto à composição química dos alimentos protéicos testados neste experimento, em relação aos valores citados na literatura. Os valores encontrados de energia metabolizável aparente e energia metabolizável aparente corrigida pelo balanço de nitrogênio em kcal/kg de alimento foram, respectivamente: farinha de vísceras de aves: 2.609 e 2.329 na primeira idade, e 2.735 e 2.664 na segunda idade; farinha de penas: 2.551 e 2.401 na primeira idade, e 2.744 e 2.641 na segunda idade; farinha de penas e vísceras: 2.352 e 2.155 na primeira idade, e 2.500 e 2.434 na segunda idade; farelo de soja: 2.248 e 2.046 na primeira idade, e 2.294 e 2.249 na segunda idade. Não houve influência da idade sobre os valores de energia metabolizável aparente, entretanto a idade influenciou os valores de energia metabolizável aparente corrigida pelo balanço de nitrogênio dos alimentos analisados.

Four proteic feeds chemical composition were evaluated, as well as the age effect in meat quails on the values of apparent metabolizable energy (AME) and the apparent corrected by the nitrogen balance (AMEn). The feeds tested were poultry by-product meal, feather meal, poultry by-product meal and feather meal and soybean meal, which have substituted 30 percent of the reference diet. It was utilized the total excrement collection, with 250 quails, males, in two different growth stages (20 to 25 and 35 to 40 days old). The experimental delineation utilized was the completely casual, in factorial scheme 4 x 2 (4 feeds x 2 periods) with 5 replicates per treatment, of 10 quails each one. Variation occurred referring to the chemical composition of the proteic feeds tested at this experiment, related to the cited values in the literature. The energy values found of apparent metabolizable energy and the apparent metabolizable energy corrected by the nitrogen balance in kcal/kg of feed were, respectively: poultry by-product meal: 2.609 and 2.329 at the first age, and 2.735 and 2.664 at the second age; feather meal: 2.551 and 2.401 at the first age, and 2.744 and 2.641 at the second age; poultry by-product meal and feather meal: 2.352 and 2.155 at the first age, and 2.500 and 2.434 at the second age; soybean meal: 2.248 and 2.046 at the first age, and 2.294 and 2.249 at the second age. It didnÆt have influence of the age at the apparent metabolizable energy values, otherwise the age influenced the apparent metabolizable energy values corrected by the nitrogen balance of the analyzed feeds.

[The effect of betain on biology and morphology of developmental stages of Eimeria acervulina in broiler chicks experimentally infected]. / Efeito do uso da betaína na biologia e morfologia dos estádios evolutivos de Eimeria acervulina em frangos de corte infectados experimentalmente com oocistos esporulados.

Purposing to investigate the betaine effect on biology and morphology of developmental stages of Eimeria acervulina, 420 broiler chicks Cobb were experimentally inoculated with 2 x 10(5) sporulated oocysts and housed in battery cages in a block design with five treatments and six replicates each, including a positive control, a group treated with salinomycin and growth promoter plus three levels of betaine as additive in the feed at 0.05, 0.10 and 0.15%. Measurements of oocysts, sporocysts and endogenous stages were performed as morphological parameters, while pre patent and patent periods and sporulation time were taken as biological parameters. Morphology was also associated with the mathematical constant Phi (1.618) to evaluate possible relationship. Betaine was able to cause modifications in both biology and morphology of oocysts and sporocysts, whereas it was weakly able to affect developmental stages based on trophozoites and macrogamonts measurements. According to the measures of sporocysts E. acervulina development was closely related to Phi.

Digestibilidade da raçäo de frangos de corte suplementados com probióticos e antibiótico / Digestibility of broiler chickens diet supplemented with probiotics and antibiotics

O objetivo deste experimento foi avaliar a digestibilidade da raçäo de frangos de corte a qual continha ou näo antibiótico e probióticos na fase inicial (um a 20 dias) e na fase final (21-40 dias). As aves foram distribuídas em um delineamento inteiramente casualizado com quatro tratamentos: Tratamento 1- Dieta Testemunha; Tratamento 2 - Dieta Testemunha + 0,02 por cento de probiótico 1 (Calsporin 10®), Tratamento 3 - Dieta Testemunha + 2,0 por cento na fase inicial e 0,63 por cento na fase final de probiótico 2 (Estibion aves®); Tratamento 4 - Dieta Testemunha + 0,013 por cento de antibiótico (Bacitracina de Zinco®) e 5 repetiçöes de 10 e 8 aves por unidade experimental por fase, respectivamente. Os pintos foram criados em gaiolas de metabolismo. Os resultados demonstram que a digestibilidade de matéria seca, nitrogênio e energia metabolizável aparente näo foi afetada pela suplementaçäo de antibiótico e probióticos na dieta de frangos de corte