Barotrauma otológico na aviação / Otological barotrauma in aviation

O barotrauma otológico é qualquer agressão à orelha média causada pelo desequilíbrio entre a pressão desta cavidade e a pressão ambiental. Na aviação, esta condição se estabelece, na maioria das vezes, durante o pouso da aeronave e é causada pelo mau funcionamento da tuba auditiva do paciente. O objetivo deste artigo é revisar a fisiopatologia e o manejo do barotrauma otológico na aviação.

The ear barotrauma is any injury in the middle ear caused by the difference between this cavity pressure and environmental pressure. In aviation, this condition is established, in majority, during the landing and is caused by poor function of the auditory tube of the patient. This article purpose is to review the physiopathology and the treatment of the ear barotrauma.

Anestésicos locais e suas aplicações nas diferentes áreas da medicina / Local anesthetics and their applications in the different areas of medicine

Anestésicos locais (ALs) são fármacos que promovem bloqueio reversível da condução nervosa, sem gerar alteração de consciência. Os ALs apresentam diversas aplicações clínicas, desde anestesia tópica de mucosas, bloqueios regionais até correção de arritmias ventriculares. São utilizados em diversas áreas que não somente a anestesia propriamente dita. (seria interessante adicionar o objetivo deste artigo aqui) Usaria ALs no texto todo.

Local Anesthetics (LA) are drugs that promote reversible blockage of neural conduction, without change in consciousness. The LAs have many clinical applications, since topic mucous anesthesia, regional blockage to even ventricular arrhythmia. They are used in many areas that not just anesthesia itself.

Doppler US measurement of the superior mesenteric artery blood flow in children and adolescents.

BACKGROUND: Blood flow volume in the superior mesenteric artery (SMA) measured by pulsed Doppler has been used in adults to evaluate Crohn disease but has not been utilized in children and adolescents. OBJECTIVE: To establish a cutoff point for normal SMA blood flow using pulsed Doppler US measurement in healthy children and adolescents. MATERIALS AND METHODS: The study included healthy volunteers from an urban community, divided into two age groups, children (5-9 years) and adolescents (10-17 years). Anthropometric measurements included waist circumference and body surface area classified according to the z-score of body mass index. Heart rate, blood pressure, oxygen saturation and temperature were measured immediately before US evaluation. RESULTS: The average age of the 60 participants was 12.2 years. Of these, 21 (35%) were ages 5-9 years and 39 (65%) were ages 10-17 years; 21 (35%) were boys. Findings of the two examiners coincided for 58 of the 60 (96.7%) participants. SMA blood flow was significantly lower in the children (mean ± SD = 556 ± 122 ml/min) than in adolescents (mean ± SD 775 ± 311 ml/min) (P < 0.001). SMA blood flow showed statistically significant positive associations with body surface area. CONCLUSION: We found that superior mesenteric artery blood flow is significantly lower in children than in adolescents and is associated with body surface area.

The impact of polymyxin B dosage on in-hospital mortality of patients treated with this antibiotic.

OBJECTIVE: To assess the impact of dosage on in-hospital mortality of patients receiving intravenous polymyxin B. METHODS: A retrospective cohort study was performed from January 2003 to December 2009. Patients ≥ 18 years receiving intravenous polymyxin B for ≥ 72 h were analysed. Clinical covariates were assessed and data were retrieved from medical records. Subgroup analyses were performed in patients with microbiologically confirmed infections and in patients with bacteraemia. Renal toxicity was also assessed. Logistic regression models (LRMs) were performed for the entire cohort and subgroups. RESULTS: A total of 276 patients were included. The overall in-hospital mortality was 60.5% (167 of 276). The final LRM showed that severe sepsis or septic shock [adjusted odds ratio (aOR) 4.07; 95% confidence interval (CI) 2.22-7.46], presence of mechanical ventilation (aOR 3.14; 95% CI 1.73-5.71), Charlson co-morbidity score (aOR 1.25; 95% CI 1.09-1.44) and age (aOR 1.02; 95% CI 1.01-1.04) were independently associated with increased in-hospital mortality, while ≥ 200 mg/day polymyxin B was associated with lower risk for this outcome (aOR 0.43; 95% CI 0.23-0.79). The effect of ≥ 200 mg/day polymyxin B on in-hospital mortality was higher in both subgroups (microbiologically documented infections and bacteraemia). Patients receiving ≥ 200 mg/day of polymyxin B had significantly higher risk of severe renal impairment. CONCLUSION: A dosage of ≥ 200 mg/day polymyxin B was associated with lower in-hospital mortality. The benefit of these higher doses outweighed the risk of severe renal dysfunction during therapy. Large prospective studies including pharmacokinetic/pharmacodynamic analysis are still required to define the best dosage regimens of polymyxin B.