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Barbosa C, Cabrita A, Dias C, Martins E. The association between pre-existing heart failure and cancer incidence: A systematic review and meta-analysis. Rev Port Cardiol 2024:S0870-2551(24)00076-3. [PMID: 38583859 DOI: 10.1016/j.repc.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/23/2023] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular diseases (CVD) and cancer are some of the most recognized causes of mortality and morbidity worldwide. Cancer is the second leading cause of death in heart failure (HF) populations. Recent studies have hypothesized that HF might promote the development and progression of cancer. We aim to analyze and discuss the most recent evidence on the relationship between HF and cancer development. METHODS From inception to November 2022, we searched PubMed, Web of Science and ClinicalTrials.gov for relevant articles on patients with HF and a subsequent cancer diagnosis that reported outcomes of overall and site-specific cancer incidence, or mortality. RESULTS Of 2401 articles identified in our original search, 13 articles met our criteria. Studies reporting risk rate estimates were summarized qualitatively. Studies reporting hazard ratios (HRs), or relative risks were combined in a meta-analysis and revealed that HF was associated with an increased overall cancer incidence with a HR=1.30 (95% CI: 1.04-1.62) compared with individuals without HF. Subgroup analyses by cancer type revealed increased risk for lung cancer (HR=1.87; 95% CI: 1.28-2.73), gastrointestinal cancer (HR=1.22; 95% CI: 1.03-1.45), hematologic cancer (HR=1.60; 95% CI: 1.23-2.08) and female reproductive cancer (HR=1.67; 95% CI: 1.27-2.21). Mortality from cancer was higher in HF patients compared with non-HF subjects with a HR=2.17 (95% CI: 1.23-3.84). CONCLUSIONS Our systematic review and meta-analysis revealed that HF may result in a subsequent increase in cancer incidence as well as in cancer-related mortality. The most common cancer subtypes in HF patients were lung, female reproductive system, and hematologic cancers. Further research is needed to understand this association better and to provide the best cardiological and oncological care.
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Affiliation(s)
- Carla Barbosa
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - André Cabrita
- Departamento de Cardiologia, Centro Hospitalar Universitário de S. João EPE, Porto, Portugal
| | - Camila Dias
- Departamento Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; CINTESIS@RISE, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Elisabete Martins
- Departamento de Cardiologia, Centro Hospitalar Universitário de S. João EPE, Porto, Portugal; CINTESIS@RISE, Faculdade de Medicina, Universidade do Porto, Portugal; Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Gerardo F, Faria D, Silvério António P, Baltazar Ferreira J, Beringuilho M, Ferreira H, Fialho I, Miranda I, Sá Pereira Y, Nunes-Ferreira A, Roque D, Santos MB, Morais C, Bravo Baptista S, Augusto JB. PrOgnosis in Pulmonary Embolism (PoPE): 30-Day mortality risk score based on five admission parameters. Rev Port Cardiol 2024; 43:1-8. [PMID: 37423312 DOI: 10.1016/j.repc.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/12/2023] [Accepted: 04/13/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE Several scoring systems have been developed for risk stratification in patients with acute pulmonary embolism (PE). The Pulmonary Embolism Severity Index (PESI) and its simplified version (sPESI) are among the most used, however the high number of variables hinder its application. Our aim was to derive an easy-to-perform score based on simple parameters obtained at admission to predict 30-day mortality in acute PE patients. METHODS Retrospective study in 1115 patients with acute PE from two institutions (derivation cohort n=835, validation cohort n=280). The primary endpoint was all-cause mortality at 30 days. Statistically and clinically relevant variables were selected for multivariable Cox regression analysis. We derived and validated a multivariable risk score model and compared to other established scores. RESULTS The primary endpoint occurred in 207 patients (18.6%). Our model included five variables weighted as follows: modified shock index ≥1.1 (hazard ratio [HR] 2.57, 1.68-3.92, p<0.001), active cancer (HR 2.27, 1.45-3.56, p<0.001), altered mental state (HR 3.82, 2.50-5.83, p<0.001), serum lactate concentration ≥2.50 mmol/L (HR 5.01, 3.25-7.72, p<0.001), and age ≥80 years (HR 1.95, 1.26-3.03, p=0.003). The prognostic ability was superior to other scores (area under curve [AUC] 0.83 [0.79-0.87] vs 0.72 [0.67-0.79] in PESI and 0.70 [0.62-0.75] in sPESI, p<0.001) and its performance in the validation cohort was deemed good (73 events in 280 patients, 26.1%, AUC=0.76, 0.71-0.82, p<0.0001) and superior to other scores (p<0.05). CONCLUSIONS The PoPE score (https://tinyurl.com/ybsnka8s) is an easy tool with superior performance to predict early mortality in patients admitted for PE with non-high-risk PE.
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Affiliation(s)
- Filipa Gerardo
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Daniel Faria
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Pedro Silvério António
- Cardiology Department, Centro Hospitalar Universitário de Lisboa Norte EPE, Hospital de Santa Maria, Lisboa, Portugal
| | | | - Marco Beringuilho
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Hilaryano Ferreira
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Inês Fialho
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Inês Miranda
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Yolanda Sá Pereira
- Internal Medicine Department, Centro Hospitalar Universitário de Lisboa Norte EPE, Hospital de Santa Maria, Lisboa, Portugal
| | - Afonso Nunes-Ferreira
- Cardiology Department, Centro Hospitalar Universitário de Lisboa Norte EPE, Hospital de Santa Maria, Lisboa, Portugal
| | - David Roque
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Miguel B Santos
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Carlos Morais
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Sérgio Bravo Baptista
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal; University Clinic of Cardiology - Faculty of Medicine at University of Lisbon, Lisbon, Portugal
| | - João B Augusto
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal; Advanced Cardiac Imaging Department, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK.
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Bala R, Mehta S, Roy VC, Kaur G, de Marvao A. Peripartum cardiomyopathy: A review. Rev Port Cardiol 2023; 42:917-924. [PMID: 37414337 DOI: 10.1016/j.repc.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 07/08/2023] Open
Abstract
Peripartum cardiomyopathy is a rare type of heart failure manifesting towards the end of pregnancy or in the months following delivery, in the absence of any other cause of heart failure. There is a wide range of incidence across countries reflecting different population demographics, uncertainty over definitions and under-reporting. Race, ethnicity, multiparity and advanced maternal age are considered important risk factors for the disease. Its etiopathogenesis is incompletely understood and is likely multifactorial, including hemodynamic stresses of pregnancy, vasculo-hormonal factors, inflammation, immunology and genetics. Affected women present with heart failure secondary to reduced left ventricular systolic function (LVEF <45%) and often with associated phenotypes such as LV dilatation, biatrial dilatation, reduced systolic function, impaired diastolic function, and increased pulmonary pressure. Electrocardiography, echocardiography, magnetic resonance imaging, endomyocardial biopsy, and certain blood biomarkers aid in diagnosis and management. Treatment for peripartum cardiomyopathy depends on the stage of pregnancy or postpartum, disease severity and whether the woman is breastfeeding. It includes standard pharmacological therapies for heart failure, within the safety restrictions for pregnancy and lactation. Targeted therapies such as bromocriptine have shown promise in early, small studies, with large definitive trials currently underway. Failure of medical interventions may require mechanical support and transplantation in severe cases. Peripartum cardiomyopathy carries a high mortality rate of up to 10% and a high risk of relapse in subsequent pregnancies, but over half of women present normalization of LV function within a year of diagnosis.
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Affiliation(s)
- Rajni Bala
- Department of Biotechnology, Punjabi University, Patiala, India; Adduct Healthcare Pvt. Ltd., Mohali, India
| | - Sakshi Mehta
- Adduct Healthcare Pvt. Ltd., Mohali, India; Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Vikas C Roy
- Department of Pharmacy, Global College of Pharmacy, Kahanpur, Punjab, India
| | - Geetika Kaur
- Integrative Biosciences Center, Wayne State University, Detroit, MI 48202, USA; Department of Ophthalmology, Visual and Anatomical Sciences, School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - Antonio de Marvao
- Department of Women and Children's Health, King's College London, London, United Kingdom; British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
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Raposeiras-Roubín S, Núñez-Gil IJ, Jamhour K, Abu-Assi E, Conty DA, Vedia O, Almendro-Delia M, Sionis A, Martin-Garcia AC, Corbí-Pascual M, Martínez-Sellés M, Uribarri A, Guillén M, Acuña JMG, País JL, Blanco E, Linares Vicente JA, Flecha ASG, Andrés M, Pérez-Castellanos A, Alonso J, Rosselló X, Romo AI, Feltes G. Long-term prognostic impact of beta-blockers in patients with Takotsubo syndrome: Results from the RETAKO Registry. Rev Port Cardiol 2023; 42:237-246. [PMID: 36634757 DOI: 10.1016/j.repc.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/14/2022] [Accepted: 02/09/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND No evidence-based therapy has yet been established for Takotsubo syndrome (TTS). Given the putative harmful effects of catecholamines in patients with TTS, beta-blockers may potentially decrease the intensity of the detrimental cardiac effects in those patients. OBJECTIVE The purpose of this study was to assess the impact of beta-blocker therapy on long-term mortality and TTS recurrence. METHODS The cohort study used the national Spanish Registry on TakoTsubo Syndrome (RETAKO). A total of 970 TTS post-discharge survivors, without pheochromocytoma, left ventricular outflow tract obstruction, sustained ventricular arrhythmias, and significant bradyarrhythmias, between January 1, 2003, and July 31, 2018, were assessed. Cox regression analysis and inverse probability weighting (IPW) propensity score analysis were used to evaluate the association between beta-blocker therapy and survival free of TTS recurrence. RESULTS From 970 TTS patients, 582 (60.0%) received beta-blockers. During a mean follow-up of 2.5±3.3 years, there were 87 deaths (3.6 per 100 patients/year) and 29 TTS recurrences (1.2 per 100 patient/year). There was no significant difference in follow-up mortality or TTS recurrence in unadjusted and adjusted Cox analysis (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.59-1.27, and 0.95, 95% CI 0.57-1.13, respectively). After weighting and adjusting by IPW, differences in one-year survival free of TTS recurrence between patients treated and untreated with beta-blockers were not found (average treatment effect -0.01, 95% CI -0.07 to 0.04; p=0.621). CONCLUSIONS In this observational nationwide study from Spain, there was no significant association between beta-blocker therapy and follow-up survival free of TTS recurrence.
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Affiliation(s)
| | - Iván J Núñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Karim Jamhour
- Cardiology Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Emad Abu-Assi
- Cardiology Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | | | - Oscar Vedia
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Aitor Uribarri
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Marta Guillén
- Cardiology Department, Hospital Joan XXIII, Tarragona, Spain
| | | | - Javier Lopez País
- Cardiology Department, Hospital Santiago de Compostela, Santiago de Compostela, Spain
| | - Emilia Blanco
- Cardiology Department, Hospital Arnau de Vilanova, Lérida, Spain
| | | | | | - Mireia Andrés
- Cardiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Joaquín Alonso
- Cardiology Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Xavier Rosselló
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Gisela Feltes
- Cardiology Department, Hospital Nuestra Señora de América, Madrid, Spain
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Palma A, Morais S, Silva PV, Pires A. Congenital heart defects and preterm birth: Outcomes from a referral center. Rev Port Cardiol 2023; 42:403-410. [PMID: 36828187 DOI: 10.1016/j.repc.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/17/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Preterm birth and congenital heart defects are two major causes of neonatal and infant mortality. However, the relationship between them has not yet been fully clarified. OBJECTIVE To determine the prevalence and spectrum of congenital heart defects in preterms, the specific associations between categories of congenital heart defects and preterm birth and to establish the influence on outcomes. METHODS Observational, case-control analysis that included 448 live births with congenital heart defects born between 2003 and 2017. Preterm with congenital heart defects were the case subjects and term neonates with congenital heart defects the control subjects. RESULTS Of the newborns with congenital heart defects, 23% were preterm. The odds of congenital heart defects in preterm were twofold higher than for term neonates (p<0.0001), even when considering only those with severe congenital heart defects (p=0.0002). The odds in preterm were 9.2-fold higher for abnormalities of the atria and atrial septum (p<0.0001) and two-fold higher for abnormalities of the ventricles and ventricular septum (p<0.0001) compared with term neonates. The neonatal mortality rate in the preterm group was not statistically different from that of the term group with congenital heart defects (p=0.799) or severe congenital heart defects (p=0.554). CONCLUSION Preterm have more than twice as many congenital heart defects as term neonates. Although the etiology of prematurity between infants with congenital heart defects is still uncertain, our findings highlight a possible relationship between prematurity and congenital heart defects.
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Affiliation(s)
- Andreia Palma
- Department of Pediatric Cardiology, Referral Center for Congenital Cardiac Defects, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Sofia Morais
- Department of Neonatology, Bissaya Barreto Maternity, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Patrícia V Silva
- Department of Pediatric Cardiology, Referral Center for Congenital Cardiac Defects, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Pires
- Department of Pediatric Cardiology, Referral Center for Congenital Cardiac Defects, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Menezes Fernandes R, Nuñez D, Marques N, Dias CC, Granja C. Surviving cardiac arrest: What happens after admission to the intensive care unit? Rev Port Cardiol 2021; 40:317-325. [PMID: 34187632 DOI: 10.1016/j.repce.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Patients successfully resuscitated from cardiac arrest (CA) are admitted to the intensive care unit (ICU) for post-resuscitation care. These patients' prognosis remains dismal, with only a minority surviving to hospital discharge. Understanding the clinical factors involved in the management of these patients is essential to improve their prognosis. OBJECTIVES To characterize the population admitted after successful reanimation from CA, and to analyze the factors associated with their outcomes. METHODS We performed a retrospective descriptive study of patients admitted to an ICU after CA over a five-year period from January 2014 to December 2018. Demographic factors, CA characteristics, early management, mortality and neurologic outcomes were analyzed. RESULTS A total of 187 patients, median age 67 years, were admitted after CA, of whom 39% suffered out-of-hospital CA; 87% had an initial non-shockable rhythm and the most frequent presumed cause was cardiac (31%). In-hospital mortality was 63%. Significant neurologic dysfunction (cerebral performance category 3 or 4) was seen in 31% of survivors at hospital discharge. Non-immediate initiation of basic life support (BLS), higher Simplified Acute Physiology Score II score and longer relative duration of vasopressor support were independent predictors of in-hospital mortality, while shockable rhythms were associated with improved survival. Higher Glasgow coma scale at ICU discharge and shorter length of ICU stay were predictors of better neurologic outcome. CONCLUSION This study highlights the positive prognostic impact of shockable rhythms, and confirms the importance of immediate initiation of BLS and prompt defibrillation, supporting the need for better training both outside and inside hospitals.
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Affiliation(s)
- Raquel Menezes Fernandes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.
| | - Daniel Nuñez
- Intensive Care Department, Centro Hospitalar Universitário do Algarve, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Nuno Marques
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Cláudia Camila Dias
- CINTESIS - Center for Health Technology and Services Research, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision, Faculty of Medicine of Porto, Portugal
| | - Cristina Granja
- CINTESIS - Center for Health Technology and Services Research, Portugal; Anesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine of Porto, Porto, Portugal
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Menezes Fernandes R, Nuñez D, Marques N, Dias CC, Granja C. Surviving cardiac arrest: What happens after admission to the intensive care unit? Rev Port Cardiol 2021; 40:317-325. [PMID: 33812706 DOI: 10.1016/j.repc.2020.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Patients successfully resuscitated from cardiac arrest (CA) are admitted to the intensive care unit (ICU) for post-resuscitation care. These patients' prognosis remains dismal, with only a minority surviving to hospital discharge. Understanding the clinical factors involved in the management of these patients is essential to improve their prognosis. OBJECTIVES To characterize the population admitted after successful reanimation from CA, and to analyze the factors associated with their outcomes. METHODS We performed a retrospective descriptive study of patients admitted to an ICU after CA over a five-year period from January 2014 to December 2018. Demographic factors, CA characteristics, early management, mortality and neurologic outcomes were analyzed. RESULTS A total of 187 patients, median age 67 years, were admitted after CA, of whom 39% suffered out-of-hospital CA; 87% had an initial non-shockable rhythm and the most frequent presumed cause was cardiac (31%). In-hospital mortality was 63%. Significant neurologic dysfunction (cerebral performance category 3 or 4) was seen in 31% of survivors at hospital discharge. Non-immediate initiation of basic life support (BLS), higher Simplified Acute Physiology Score II score and longer relative duration of vasopressor support were independent predictors of in-hospital mortality, while shockable rhythms were associated with improved survival. Higher Glasgow coma scale at ICU discharge and shorter length of ICU stay were predictors of better neurologic outcome. CONCLUSION This study highlights the positive prognostic impact of shockable rhythms, and confirms the importance of immediate initiation of BLS and prompt defibrillation, supporting the need for better training both outside and inside hospitals.
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Affiliation(s)
- Raquel Menezes Fernandes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.
| | - Daniel Nuñez
- Intensive Care Department, Centro Hospitalar Universitário do Algarve, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Nuno Marques
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Cláudia Camila Dias
- CINTESIS - Center for Health Technology and Services Research, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision, Faculty of Medicine of Porto, Portugal
| | - Cristina Granja
- CINTESIS - Center for Health Technology and Services Research, Portugal; Anesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine of Porto, Porto, Portugal
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de Sousa C, Ribeiro RM, Pinto FJ. The burden of infective endocarditis in Portugal in the last 30 years - a systematic review of observational studies. Rev Port Cardiol 2021; 40:205-217. [PMID: 33648807 DOI: 10.1016/j.repc.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/16/2020] [Accepted: 07/15/2020] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Infective endocarditis affects cardiac valves or devices and has a potentially uncertain prognosis. Little information is available on the epidemiology of this disease in Portugal. OBJECTIVE A systematic review of all evidence published in the last 30 years to assess epidemiological data in patients hospitalized with infective endocarditis in Portuguese hospital centers. METHODS Extensive search of all published evidence using Medline, Scopus, general search databases and in addition Portuguese medical journals was performed. All relevant studies in Portuguese or English that reported short- or long-term mortality were included. RESULTS Eighteen retrospective cohort studies (15 medical and three surgical series) were included with a total of 1872 patients assessed. The medical series included 1279 patients. Older males with predominant native left heart valve involvement were identified. Staphylococcus and streptococcus were the most frequent reported pathogens. Surgical intervention was performed on average in 29.8% of cases. The short-term mortality rate ranged from three to 37.2% (average 21.9%). Surgical cases involved older males with affected native left heart valves, emergent/urgent indication was dominant and short-term mortality ranged from 13.6 to 16%. CONCLUSIONS The current study provides a descriptive analysis of the published series of infective endocarditis in Portugal over the last 30 years. Therefore, it may serve as a starting point for the development and implementation of a multicentric prospective registry on infective endocarditis patients in Portugal that will allow a better and more accurate characterization of this special patient population.
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Affiliation(s)
- Catarina de Sousa
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Serviço de Cardiologia, Centro Hospitalar Barreiro Montijo (CHBM), EPE, Barreiro, Portugal.
| | - Ruy M Ribeiro
- Laboratório de Biomatemática, Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Departamento Coração e Vasos, Centro Hospitalar e Universitário Lisboa Norte (CHULN), EPE, Lisboa, Portugal
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Miranda CA, Meletti JFA, Lima LHN, Marchi E. [Perioperative central venous oxygen saturation and its correlation with mortality during cardiac surgery: an observational prospective study]. Rev Bras Anestesiol 2020; 70:484-90. [PMID: 32868031 DOI: 10.1016/j.bjan.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cardiac surgery can produce persistent deficit in the ratio of Oxygen Delivery (DO2) to Oxygen Consumption (VO2). Central venous oxygen Saturation (ScvO2) is an accessible and indirect measure of DO2/VO2 ratio. OBJECTIVE To monitor perioperative ScvO2 and assess its correlation with mortality during cardiac surgery. METHODS This prospective observational study evaluated 273 patients undergoing cardiac surgery. Blood gas samples were collected to measure ScvO2 at three time points: T0 (after anesthetic induction), T1 (end of surgery), and T2 (24hours after surgery). The patients were divided into two groups (survivors and nonsurvivors). The following outcomes were analyzed: intrahospital mortality, length of Intensive Care Unit (ICU) and hospital stay (LOS), and variation in ScvO2. RESULTS Of the 273 patients, 251 (92%) survived and 22 (8%) did not. There was a significant perioperative reduction of ScvO2 in both survivors (T0=78%± 8.1%, T1=75.4%±7.5%, and T2=68.5%±9%; p<0.001) and nonsurvivors (T0=74.4%±8.7%, T1=75.4%±7.7%, and T2=66.7%±13.1%; p <0.001). At T0, the percentage of patients with ScvO2 <70% was greater in the nonsurvivor group (31.8% vs. 13.1%; p=0.046) and the multiple logistic regression showed that ScvO2 is an independent risk factor associated with death, OR=2.94 (95% CI 1.10-7.89) (p=0.032). The length of ICU and LOS were 3.6±3.1 and 7.4±6.0 days respectively and was not significantly associated with ScvO2. CONCLUSIONS Early intraoperative ScvO2 <70% indicated a higher risk of death. A perioperative reduction of ScvO2 was observed in patients undergoing cardiac surgery, with high intraoperative and lower postoperative levels.
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Ferreira MCDR, Lima EQ. Impact of the development of acute kidney injury on patients admitted to the pediatric intensive care unit. J Pediatr (Rio J) 2020; 96:576-581. [PMID: 31344338 PMCID: PMC9432065 DOI: 10.1016/j.jped.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To identify the risk factors for the development of acute kidney injury and for short and long-term mortality of patients with acute kidney injury after admission to the Pediatric Intensive Care Unit. MATERIALS AND METHODS Retrospective analysis of patients admitted to the Pediatric Intensive Care Unit from January 2004 to December 2008. Acute kidney injury was defined by the KDIGO criterion. Risk factors for acute kidney injury, in-hospital, and long-term mortality were obtained through multivariate logistic regression analysis. Long-term mortality (up to 2011) was obtained by searching the institution's database and by telephone contact with patients' family members. RESULTS A total of 434 patients were evaluated and the incidence of acute kidney injury was 64%. Most acute kidney injury episodes (78%) occurred within the first 24hours after admission to the Pediatric Intensive Care Unit. The risk factors for the development of acute kidney injury were: low volume of diuresis, younger age, mechanical ventilation, vasoactive drugs, diuretics, and amphotericin. Lower weight, positive fluid balance, acute kidney injury, dopamine use and mechanical ventilation were independent risk factors for in-hospital mortality. Long-term mortality was 17.8%. Systolic blood pressure, PRISM score, low volume of diuresis, and mechanical ventilation were independent risk factors associated with long-term mortality after admission to the Pediatric Intensive Care Unit. CONCLUSION Acute kidney injury was a frequent, early event, and was associated with in-hospital mortality and long-term mortality after admission to the Pediatric Intensive Care Unit.
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Affiliation(s)
| | - Emerson Quintino Lima
- Hospital de Base de São José do Rio Preto, Departamento de Nefrologia, São José do Rio Preto, SP, Brazil
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11
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Bal KK, Unal M, Delialioglu N, Oztornaci RO, Ismi O, Vayisoglu Y. Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients. Braz J Otorhinolaryngol 2020; 88:511-522. [PMID: 32868223 PMCID: PMC9422577 DOI: 10.1016/j.bjorl.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/20/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
Introductıon Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options. Objectives Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media. Methods A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years. Results According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008). Conclusions Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.
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Affiliation(s)
- Kemal Koray Bal
- University of Health Sciences Adana City Hospital, Department of Otorhinolaryngology & Head and Neck Surgery, Adana, Turkey.
| | - Murat Unal
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Nuran Delialioglu
- University of Mersin, Faculty of Medicine, Department of Microbiology, Mersin, Turkey
| | - Ragip Onur Oztornaci
- University of Mersin, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin, Turkey
| | - Onur Ismi
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Yusuf Vayisoglu
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
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12
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Pitchon RR, Alvim CG, Andrade CR, Lasmar LMLBF, Cruz ÁA, Reis APD. Asthma mortality in children and adolescents of Brazil over a 20-year period. J Pediatr (Rio J) 2020; 96:432-8. [PMID: 31009618 DOI: 10.1016/j.jped.2019.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/31/2018] [Accepted: 02/05/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the number of asthma deaths and the temporal trend of the asthma-specific mortality rate in children and adolescents up to 19 years of age in Brazil. METHODS This is an ecological time-series study of asthma deaths reported in Brazil, in the population up to 19 years of age, between 1996 and 2015. The specific asthma mortality rate and its temporal trend were analyzed. RESULTS There were 5014 deaths during the 20 years evaluated, with the majority, 68.1%, being recorded in children under 5 years of age. The specific asthma mortality rate ranged from 0.57/100,000 in 1997 to 0.21/100,000 in 2014, with a significant reduction of 59.8%. Regarding the place of death, 79.4% occurred in a hospital setting. In this sample, the adolescents had a 1.5-fold higher chance of death out-of-hospital than children up to nine years of age. There was no significant difference in the temporal trend between the genders and no significant decrease in out-of-hospital deaths. CONCLUSIONS This study found a temporal trend for a reduction in asthma deaths over 20 years in children and adolescents in Brazil. Mortality rates varied across the geographic regions of the country and were higher in the Northeast. The prevalence of deaths under 5 years of age may be associated with the greater vulnerability of this age group in low-income countries. In adolescence, deaths outside the hospital environment are noteworthy. Asthma deaths are rare but unacceptable events, considering the treatable nature of the disease and the presence of avoidable factors in most of fatal outcomes.
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13
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Victora JD, Silveira MF, Tonial CT, Victora CG, Barros FC, Horta BL, Santos ISD, Bassani DG, Garcia PCR, Scheeren M, Fiori HH. Prevalence, mortality and risk factors associated with very low birth weight preterm infants: an analysis of 33 years. J Pediatr (Rio J) 2020; 96:327-332. [PMID: 30550758 PMCID: PMC9432241 DOI: 10.1016/j.jped.2018.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/03/2018] [Accepted: 10/17/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the prevalence, mortality and risk factors associated with the birth of very low birth weight preterm infants over a period of 33 years. METHODS Four cross-sectional studies were analyzed, using data from perinatal interviews of birth cohorts in the city of Pelotas collected in 1982, 1993, 2004, and 2015. Based on perinatal questionnaires, anthropometric measurements of newborns and death certificates were analyzed to obtain the prevalence rate, neonatal mortality, and risk factors (maternal age, income and type of delivery) for very low birth weight. RESULTS A total of 19,625 newborns were included in the study. In the years 1982, 1993, 2004, and 2015, there were, respectively, 5909, 5232, 4226, and 4258 births. The prevalence of very low birth weight was, respectively, 1.1% (n=64), 0.9% (n=46), 1.4% (n=61), and 1.3% (n=54). There was no statistical evidence of an increasing trend over time (p=0.11). Among the risk factors, family income in the three poorest quintiles was associated with prevalence rates that were approximately twice as high as in the richest quintile (p=0.003). Mortality per 1000 live births for neonates weighing <1500g decreased from 688 to 259 per thousand from 1982 to 2015 (p<0.001), but still represented 61% of neonatal deaths in the latter year. CONCLUSION Although mortality in very low birth weight decreased by more than 60% in recent years, this group still contributes with more than half of neonatal deaths. Low family income remains an important risk factor in this scenario.
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Affiliation(s)
- Julia Damiani Victora
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | | | - Cristian Tedesco Tonial
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil.
| | - Cesar Gomes Victora
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Fernando Celso Barros
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Bernardo Lessa Horta
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Iná Silva Dos Santos
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Diego Garcia Bassani
- University of Toronto, Center for Global Child Health, The Hospital for Sick Children and Department of Pediatrics, Toronto, Canada
| | - Pedro Celiny R Garcia
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Marola Scheeren
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Humberto H Fiori
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
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14
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Guiomar N, Vaz-da-Silva M, Mbala D, Sousa-Pinto B, Monteiro JP, Ponce P, Carneiro F, M Guerra, Neves F, Ferraz R, Rijo D, Teixeira M, Vouga L, Braga P. Cardiac surgery in infective endocarditis and predictors of in-hospital mortality. Rev Port Cardiol 2020; 39:137-149. [PMID: 32340853 DOI: 10.1016/j.repc.2019.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/10/2019] [Accepted: 08/01/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Infective endocarditis (IE) is a serious disease with significant in-hospital mortality (15-30%) despite advances in medical and surgical therapy. AIMS To perform a clinical characterization of patients undergoing cardiac surgery for IE and to identify factors that predict in-hospital mortality. METHODS We retrospectively analyzed 145 patients with IE admitted between January 2006 and October 2017. RESULTS The median age was 72 years. IE was acquired mainly in the community (69%), and involved the native aortic valve in 54% of patients, biological prosthetic valves in 22.1% and mechanical valves in 10.3%. Staphylococcus spp. (31.0%) were the most frequent etiological agents. Cardiac surgery was emergent in 29 patients, urgent in 108, and elective in eight. The main indications were heart failure (57.9%), large vegetations (20%), systemic embolism (17.2%) and valve dysfunction (15.2%). Overall, biological valves were implanted in 62.1% of patients and mechanical valves in 37.2%. A total of 19 patients (13.1%) died. Predictors of mortality were preoperative atrial fibrillation and lower left ventricular ejection fraction, postoperative severe valve regurgitation associated with cardiogenic shock, sepsis, septic shock associated with cardiogenic shock, cardiac tamponade, need for renal replacement therapy and, although without statistical significance, emergent surgery. CONCLUSIONS There is a need for better indicators to enable early identification of surgical candidates for IE, implementation of a heart team, and better surgical strategies, including more rapid intervention, more specific postoperative care, and optimal antibiotic therapy.
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Affiliation(s)
- Neusa Guiomar
- Serviço de Cardiologia do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - M Vaz-da-Silva
- Faculdade de Medicina da Universidade do Porto e Serviço de Cardiologia do Centro Hospitalar S. João, Porto, Portugal
| | - D Mbala
- Serviço de Cardiologia do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - B Sousa-Pinto
- Cintesis, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - J P Monteiro
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Ponce
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - F Carneiro
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Guerra
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - F Neves
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Ferraz
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - D Rijo
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Teixeira
- Serviço de Cardiologia do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - L Vouga
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Braga
- Serviço de Cardiologia do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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15
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Teixeira DC, Diniz LMO, Guimarães NS, Moreira HMDAS, Teixeira CC, Romanelli RMDC. Risk factors associated with the outcomes of pediatric bacterial meningitis: a systematic review. J Pediatr (Rio J) 2020; 96:159-167. [PMID: 31437421 PMCID: PMC9432045 DOI: 10.1016/j.jped.2019.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to systematically review the literature and answer the following central question: "What are the risk factors associated with worse clinical outcomes of pediatric bacterial meningitis patients?" METHODS The articles were obtained through literary search using electronic bibliographic databases: Web of Science, Scopus, MEDLINE, and LILACS; they were selected using the international guideline outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols. RESULTS The literature search identified 1,244 articles. After methodological screening, 17 studies were eligible for this systematic review. A total of 9,581 patients aged between 0 days and 18 years were evaluated in the included studies, and several plausible and important prognostic factors are proposed for prediction of poor outcomes after bacterial meningitis in childhood. Late diagnosis reduces the chances for a better evolution and reinforces the importance of a high diagnostic suspicion of meningitis, especially in febrile pictures with nonspecific symptomatology. S. pneumoniae as a causative pathogen was demonstrated to be related to clinical severity. CONCLUSIONS Early prediction of an adverse outcome may help determine which children require more intensive or longer follow-up and may provide the physician with rationale for parental counseling about their child's prognosis in an early phase of the disease.
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Affiliation(s)
- Daniela Caldas Teixeira
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Belo Horizonte, MG, Brazil.
| | - Lilian Martins Oliveira Diniz
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Belo Horizonte, MG, Brazil; Faculdade de Medicina de Barbacena, Barbacena, MG, Brazil
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Abstract
OBJECTIVE Review the main aspects of the definition, diagnosis, and management of pediatric patients with sepsis and septic shock. SOURCE OF DATA A search was carried out in the MEDLINE and Embase databases. The articles were chosen according to the authors' interest, prioritizing those published in the last five years. SYNTHESIS OF DATA Sepsis remains a major cause of mortality in pediatric patients. The variability of clinical presentations makes it difficult to attain a precise definition in pediatrics. Airway stabilization with adequate oxygenation and ventilation if necessary, initial volume resuscitation, antibiotic administration, and cardiovascular support are the basis of sepsis treatment. In resource-poor settings, attention should be paid to the risks of fluid overload when administrating fluids. Administration of vasoactive drugs such as epinephrine or norepinephrine is necessary in the absence of volume response within the first hour. Follow-up of shock treatment should adhere to targets such as restoring vital and clinical signs of shock and controlling the focus of infection. A multimodal evaluation with bedside ultrasound for management after the first hours is recommended. In refractory shock, attention should be given to situations such as cardiac tamponade, hypothyroidism, adrenal insufficiency, abdominal catastrophe, and focus of uncontrolled infection. CONCLUSIONS The implementation of protocols and advanced technologies have reduced sepsis mortality. In resource-poor settings, good practices such as early sepsis identification, antibiotic administration, and careful fluid infusion are the cornerstones of sepsis management.
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Affiliation(s)
- Pedro Celiny Ramos Garcia
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Faculdade de Medicina e Terapia Intensiva Pediátrica, Programa de Pós-Graduação em Pediatria e Saúde Infantil, Porto Alegre, RS, Brazil
| | - Cristian Tedesco Tonial
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Faculdade de Medicina e Terapia Intensiva Pediátrica, Departamento de Pediatria, Porto Alegre, RS, Brazil.
| | - Jefferson Pedro Piva
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Departamento de Emergência e Cuidados Intensivos Pediátricos, Porto Alegre, RS, Brazil
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17
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Silva DDJN, Casimiro LGG, Oliveira MISD, Ferreira LBDC, Abelha FJPA. [The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes]. Rev Bras Anestesiol 2020; 70:3-8. [PMID: 32164996 DOI: 10.1016/j.bjan.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 10/15/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The elderly population is an especially heterogeneous group of patients with a rising number of surgical interventions being performed in the very elderly patient. The aim of this study was to evaluate the correlation between different age strata and functional status with the surgical outcome of the elderly patient. METHODS Retrospective cohort study conducted in a Surgical Intensive Care Unit (SICU), between 2006 and 2013. A total of 2331 surgical patients ≥ 65 years old were included. Patients were grouped according to age: Older Elderly Group (OEG: 65-85 years old); Very Elderly Group (VEG > 85 years old). Demographic and perioperative data were recorded. Revised Cardiac Risk Index, APACHE II and SAPS II scores were calculated and postoperative complications were documented. Variables were compared on univariate analysis. RESULTS The incidence of the VEG was 5.4%. This group had a higher proportion of non-elective surgery (22.4% vs. 11.2%, p < 0.001), higher APACHE II (12.0 vs. 10.0, p < 0.001) and SAPS II (26.6 vs. 22.2, p < 0.001) scores, higher incidence of organ failure (24.6% vs. 17.6%, p = 0.048) and a higher mortality rate during SICU (14.0% vs. 5.2%, p = 0.026) and hospital stay (9.3% vs. 5.0%, p = 0.012). CONCLUSION We found that very elderly patients represented a significant proportion of patients admitted to the SICU. They had higher severity scores with a higher prevalence of organ failure and were more likely to undergo non-elective surgery. They had worse outcomes in regarding mortality during SICU and hospital stay.
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Affiliation(s)
| | | | | | | | - Fernando José Pereira Alves Abelha
- Centro Hospitalar Universitário São João, Serviço de Anestesiologia, Porto, Portugal; Universidade do Porto, Faculdade de Medicina, Departamento de Cirurgia e Fisiologia, Porto, Portugal.
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Agostinho JR, Gonçalves I, Rigueira J, Aguiar-Ricardo I, Nunes-Ferreira A, Santos R, Guimarães T, Alves P, Cunha N, Rodrigues T, André ŃZ, Pedro M, Veiga F, Pinto FJ, Brito D. Protocol-based follow-up program for heart failure patients: Impact on prognosis and quality of life. Rev Port Cardiol 2020; 38:755-764. [PMID: 32005587 DOI: 10.1016/j.repc.2019.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 03/08/2019] [Accepted: 03/31/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Heart failure is associated with high rates of readmission and mortality, and there is a need for measures to improve outcomes. This study aims to assess the impact of the implementation of a protocol-based follow-up program for heart failure patients on readmission and mortality rates and quality of life. METHODS A quasi-experimental study was performed, with a prospective registry of 50 consecutive patients discharged after hospitalization for acute heart failure. The study group was followed by a cardiologist at days 7-10 and the first, third, sixth and 12th month after discharge, with predefined procedures. The control group consisted of patients hospitalized for heart failure prior to implementation of the program and followed on a routine basis. RESULTS No significant differences were observed between the two groups regarding mean age (67.1±11.2 vs. 65.8±13.4 years, p=0.5), NYHA functional class (p=0.37), or median left ventricular ejection fraction (27% [19.8-35.3] vs. 29% [23.5-40]; p=0.23) at discharge. Mean follow-up after discharge was similar (11±5.3 vs. 10.9±5.5 months, p=0.81). The protocol-based follow-up program was associated with a significant reduction in all-cause readmission (26% vs. 60%, p=0.003), heart failure readmission (16% vs. 36%, p=0.032), and mortality (4% vs. 20%, p=0.044). In the study group there was a significant improvement in all quality of life measures (p<0.001). CONCLUSION A protocol-based follow-up program for patients with heart failure led to a significant reduction in readmission and mortality rates, and was associated with better quality of life.
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Affiliation(s)
- João R Agostinho
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - Inês Gonçalves
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Joana Rigueira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Inês Aguiar-Ricardo
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Afonso Nunes-Ferreira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Rafael Santos
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Tatiana Guimarães
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Pedro Alves
- Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Nelson Cunha
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Tiago Rodrigues
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - ŃZinga André
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Mónica Pedro
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Fátima Veiga
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Dulce Brito
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
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Alegria S, Costa J, Vaz-Carneiro A, Caldeira D. Cochrane Corner: Perioperative beta-blockers for preventing surgery-related mortality and morbidity. Rev Port Cardiol 2020; 38:691-694. [PMID: 31928792 DOI: 10.1016/j.repc.2018.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/28/2018] [Indexed: 10/25/2022] Open
Abstract
Randomized controlled trials have yielded conflicting results regarding the impact of beta-blockers on perioperative cardiovascular morbidity and mortality. This Cochrane systematic review assessed the impact of this intervention on mortality and cardiovascular events. Eighty-eight randomized controlled trials with 19 161 participants were included (53 trials on cardiac surgery and 35 trials on non-cardiac surgery). In cardiac surgery perioperative beta-blockers had a protective effect against supraventricular and ventricular arrhythmias but had no significant effect on mortality or on the occurrence of acute myocardial infarction (AMI), stroke, heart failure, hypotension or bradycardia. In non-cardiac surgery, beta-blockers had a protective effect against AMI and arrhythmias, but this was counterbalanced by an increased risk of death and stroke. In conclusion, perioperative use of beta-blockers appears overall to be beneficial in cardiac surgery. However, in non-cardiac surgery the substantial reduction in rhythm disturbances and AMI appears to be offset by an increase in mortality and stroke, and so the systematic use of beta-blockers in this setting is not recommended.
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Affiliation(s)
- Sofia Alegria
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - João Costa
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Centro Colaborador Português da Rede Cochrane Iberoamericana, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - António Vaz-Carneiro
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Centro Colaborador Português da Rede Cochrane Iberoamericana, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Daniel Caldeira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHLN), CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
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Santos DMD, Quintans JSS, Quintans-Junior LJ, Santana-Filho VJ, Cunha CLPD, Menezes IAC, Santos MRV. [Association between peripheral perfusion, microcirculation and mortality in sepsis: a systematic review]. Rev Bras Anestesiol 2019; 69:605-21. [PMID: 31826803 DOI: 10.1016/j.bjan.2019.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/17/2019] [Accepted: 09/07/2019] [Indexed: 11/24/2022] Open
Abstract
Although increasing evidence supports the monitoring of peripheral perfusion in septic patients, no systematic review has been undertaken to explore the strength of association between poor perfusion assessed in microcirculation of peripheral tissues and mortality. A search of the most important databases was carried out to find articles published until February 2018 that met the criteria of this study using different keywords: sepsis, mortality, prognosis, microcirculation and peripheral perfusion. The inclusion criteria were studies that assessed association between peripheral perfusion/microcirculation and mortality in sepsis. The exclusion criteria adopted were: review articles, animal/pre-clinical studies, meta-analyzes, abstracts, annals of congress, editorials, letters, case-reports, duplicate and articles that did not present abstracts and/or had no text. In the 26 articles were chosen in which 2465 patients with sepsis were evaluated using at least one recognized method for monitoring peripheral perfusion. The review demonstrated a heterogeneous critically ill group with a mortality-rate between 3% and 71% (median=37% [28%-43%]). The most commonly used methods for measurement were Near-Infrared Spectroscopy (NIRS) (7 articles) and Sidestream Dark-Field (SDF) imaging (5 articles). The vascular bed most studied was the sublingual/buccal microcirculation (8 articles), followed by fingertip (4 articles). The majority of the studies (23 articles) demonstrated a clear relationship between poor peripheral perfusion and mortality. In conclusion, the diagnosis of hypoperfusion/microcirculatory abnormalities in peripheral non-vital organs was associated with increased mortality. However, additional studies must be undertaken to verify if this association can be considered a marker of the gravity or a trigger factor for organ failure in sepsis.
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Barbosa TDA, Souza AMFD, Leme FCO, Grassi LDV, Cintra FB, Lima RME, Gumieiro DN, Lima LHNE. [Perioperative complications and mortality in elderly patients following surgery for femoral fracture: prospective observational study]. Rev Bras Anestesiol 2019; 69:569-579. [PMID: 31722793 DOI: 10.1016/j.bjan.2019.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/30/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Perioperative management of femoral fractures in elderly patients has been studied to determine modifiable causes of complications and death. The aim of this study was to evaluate the mortality rate and its causes in the elderly population with FF. We also evaluated perioperative complications and their association with postoperative mortality. METHOD In this prospective and observational study, we evaluated 182 patients, by questionnaire and electronic medical record, from the moment of hospitalization to one year after surgery. Statistical analyzes using the multivariate Cox proportional hazards model and Kaplan-Meier curves were performed to detect independent mortality factors. RESULTS Fifty-six patients (30.8%) died within one year after surgery, and the main cause of death was infection followed by septic shock. The main complication, both preoperatively and postoperatively, was hydroelectrolytic disorder. For every one-unit (one-year) increase in age, the odds ratio for death increased by 4%. With each new preoperative complication, the odds ratio for death increased by 28%. Patients ASA III or IV had a 95% higher odds ratio for death than patiets ASA I or II. CONCLUSIONS Increasing age and number of preoperative complications, in addition to ASA classification III or IV, were independent factors of increased risk of death in the population studied. The mortality rate was 30.8%, and infection followed by septic shock was the leading cause of death.
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Affiliation(s)
- Talita de Almeida Barbosa
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatu, SP, Brasil; Cooperativa dos Anestesiologistas de Ribeirão Preto, Ribeirão Preto, SP, Brasil.
| | | | | | | | | | - Rodrigo Moreira E Lima
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Serviço de Anestesiologia, Botucatu, SP, Brasil
| | - David Nicoletti Gumieiro
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
| | - Lais Helena Navarro E Lima
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
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Ramos GF, Ribeiro VP, Mercadante MP, Ribeiro MP, Delgado AF, Farhat SCL, Leal MM, Marques HH, Odone-Filho V, Tannuri U, Carvalho WB, Grisi SJ, Carneiro-Sampaio M, Silva CA. Mortality in adolescents and young adults with chronic diseases during 16 years: a study in a Latin American tertiary hospital. J Pediatr (Rio J) 2019; 95:667-73. [PMID: 30030985 DOI: 10.1016/j.jped.2018.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To evaluate mortality in adolescents and young adult patients with chronic diseases followed in a Latin American tertiary hospital. METHODS A cross-sectional retrospective study was performed in a tertiary/academic hospital in the state of São Paulo, Brazil. Death occurred in 529/2850 (18.5%) adolescents and young adult patients with chronic diseases, and 25/529 (4.7%) were excluded due to incomplete medical charts. Therefore, 504 deaths were evaluated. RESULTS Deaths occurred in 316/504 (63%) of early adolescent patients and in 188/504 (37%) of late adolescent/young adult patients. Further comparisons between early adolescents (n=316) and late adolescent/young adult patients (n=188) with pediatric chronic diseases at the last hospitalization showed that the median disease duration (22.0 [0-173] vs. 43.0 [0-227] months, p<0.001) was significantly lower in early adolescents vs. late adolescent/young adult patients. The median number of previous hospitalizations was significantly lower in the former group (4.0 [1-45] vs. 6.0 [1-52], p<0.001), whereas the last hospitalization in intensive care unit was significantly higher (60% vs. 47%, p=0.003). Regarding supportive measures, palliative care was significantly lower in the younger group compared to the older group (33% vs. 43%, p=0.02). The frequencies of renal replacement therapy (22% vs. 13%, p=0.02), vasoactive agents (65% vs. 54%, p=0.01), and transfusion of blood products (75% vs. 66%, p=0.03) were significantly higher in the younger group. The five most important etiologies of pediatric chronic diseases were: neoplasias (54.2%), hepatic diseases/transplantation (10%), human immunodeficiency virus (5.9%), and childhood-onset systemic lupus erythematosus and juvenile idiopathic arthritis (4.9%). Autopsy was performed in 58/504 (11%), and discordance between clinical and postmortem diagnoses was evidenced in 24/58 (41.3%). CONCLUSIONS Almost 20% of deaths occurred in adolescents and young adults with distinct supportive care and severe disease patterns. Discordance between clinical diagnosis and autopsy was frequently observed.
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Moura Ferreira J, Moura-Ferreira S, Baptista R, Ferreira R, Madaleno J, Silva N, Ferreira MJ, Pego M. Keeping prognostic assessment simple: The value of clinical features in normotensive cancer patients with pulmonary embolism. Rev Port Cardiol 2019; 38:407-15. [PMID: 31307728 DOI: 10.1016/j.repc.2018.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 06/24/2018] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Although normotensive cancer patients with acute pulmonary embolism (PE) are a heterogeneous population, most validated clinical prognostic scores classify these patients as high-risk individuals, which limits their usefulness in this setting. In this study, we aimed to identify readily available clinical predictors of overall 30-day and one-year mortality in normotensive cancer patients with PE. METHODS AND RESULTS We performed a retrospective single-center study that included all normotensive cancer patients with PE diagnosed by multidetector computed tomography (MDCT) during emergency department stay between January 2010 and December 2011. Clinical, MDCT and laboratory variables were collected for all patients. A total of 69 patients were included. All-cause mortality was 28% and 55% at 30 days and one year of follow-up, respectively. Lower mean arterial pressure, higher lactate level and a higher Shock Index (SI) at hospital admission were associated with increased all-cause mortality at 30 days and one year of follow-up. The simplified Pulmonary Embolism Severity Index was not a predictor of short- or long-term mortality. An SI of ≥0.7 was found to be associated with lower event-free survival in both short- and long-term follow-up (hazard ratio 7.20 [95% CI, 1.66-31.21, p<0.01] and 3.51 [95% CI, 1.70-7.25, p<0.01], respectively). CONCLUSIONS This is the first article reporting the value of the SI, a user-friendly and readily available clinical tool, as an independent and accurate predictor of 30-day and one-year all-cause mortality in normotensive cancer patients with symptomatic PE.
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Garcia LP, Fernandes CM, Traebert J. Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil. J Pediatr (Rio J) 2019; 95:194-200. [PMID: 29444451 DOI: 10.1016/j.jped.2017.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/15/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To analyze the risk factors for neonatal death in Florianópolis, the Brazilian city capital with the lowest infant mortality rate. METHOD Data were extracted from a historical cohort with 15,879 live births. A model was used that included socioeconomic, behavioral, and health service use risk factors, as well as the Apgar score and biological factors. Risk factors were analyzed by hierarchical logistic regression. RESULTS Based on the multivariate analysis, socioeconomic factors showed no association with death. Insufficient prenatal consultations showed an OR of 3.25 (95% CI: 1.70-6.48) for death. Low birth weight (OR 8.42; 95% CI: 3.45-21.93); prematurity (OR 5.40; 95% CI: 2.22-13.88); malformations (OR 4.42; 95% CI: 1.37-12.43); and low Apgar score at the first (OR 6.65; 95% CI: 3.36-12.94) and at the fifth (OR 19.78; 95% CI: 9.12-44.50) minutes, were associated with death. CONCLUSION Differing from other studies, socioeconomic conditions were not associated with neonatal death. Insufficient prenatal consultations, low Apgar score, prematurity, low birth weight, and malformations showed an association, reinforcing the importance of prenatal access universalization and its integration with medium and high-complexity neonatal care services.
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Affiliation(s)
- Leandro Pereira Garcia
- Universidade do Sul de Santa Catarina (UNISUL), Departamento de Ciências da Saúde, Palhoça, SC, Brazil.
| | - Camila Mariano Fernandes
- Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brazil
| | - Jefferson Traebert
- Universidade do Sul de Santa Catarina (UNISUL), Departamento de Ciências da Saúde, Palhoça, SC, Brazil
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García-Muñoz Rodrigo F, García Cruz L, Galán Henríquez G, Urquía Martí L, Rivero Rodríguez S, García-Alix A, Figueras Aloy J. Variations in the number of births by day of the week, and morbidity and mortality in very-low-birth-weight infants. J Pediatr (Rio J) 2019; 95:41-47. [PMID: 29197224 DOI: 10.1016/j.jped.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients. METHODS This was a retrospective analysis of data collected prospectively in the Spanish SEN1500 network (2002-2011). Outborn infants, patients with major congenital anomalies, and those who died in the delivery room were excluded. Births were grouped into "weekdays" and "weekends." A multivariate logistic regression analysis was conducted to evaluate the independent effect of the birth moment on outcomes, and Cox regression for survival. RESULTS Out of a total of 27,205 very low birth weight infants born at and/or admitted to the participating centers, 22,961 (84.4%) met inclusion criteria. A reduction of 24% in the number of births was observed during the "weekends" compared with "weekdays". In the raw analysis, patients born on weekends exhibited higher morbidity and mortality (mortality rate: 14.2% vs. 16.5%, p<0.001), but differences were no longer significant after adjusting for confounding factors. CONCLUSIONS The present results suggest that current care practices reduce the proportion of births during the weekends and tend to cluster some high-risk births during this period, increasing crude morbidity and mortality. However, after adjusting for confounding factors, the differences disappear, suggesting that overall care coverage in these centers is appropriate.
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Affiliation(s)
- Fermín García-Muñoz Rodrigo
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain.
| | - Loida García Cruz
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
| | - Gloria Galán Henríquez
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
| | - Lourdes Urquía Martí
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
| | - Sonia Rivero Rodríguez
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
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Abreu G, Azevedo P, Galvão Braga C, Vieira C, Álvares Pereira M, Martins J, Arantes C, Rodrigues C, Salgado A, Marques J. Modified shock index: A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation. Rev Port Cardiol 2018; 37:481-488. [PMID: 29807676 DOI: 10.1016/j.repc.2017.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/25/2017] [Accepted: 07/13/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Prompt identification of higher-risk patients presenting with ST-segment elevation myocardial infarction (STEMI) is crucial to pursue a more aggressive approach. OBJECTIVE We aimed to assess whether the modified shock index (MSI), the ratio of heart rate to mean arterial pressure, could predict six-month mortality among patients admitted with STEMI. METHODS A retrospective observational cohort study was performed in a single center including 1158 patients diagnosed with STEMI, without cardiogenic shock on admission, between July 2009 and December 2014. They were divided into two groups: group 1 - patients with MSI<0.93 (72%); group 2 - patients with MSI≥0.93 (28%). The primary endpoint was six-month all-cause mortality. RESULTS MSI≥0.93 identified patients who were more likely to have signs of heart failure (p=0.002), anemia (p<0.001), renal insufficiency (p=0.014) and left ventricular systolic dysfunction (p=0.045). They more often required inotropic support (p<0.001), intra-aortic balloon pump (p<0.001) and mechanical ventilation (p<0.001). Regarding in-hospital adverse events, they had a higher prevalence of malignant arrhythmias (p=0.01) and mechanical complications (p=0.027). MSI≥0.93 was an independent predictor of overall six-month mortality (adjusted HR 2.00, 95% CI 1.20-3.34, p=0.008). CONCLUSION MSI was shown to be a valuable bedside tool which can rapidly identify high-risk STEMI patients at presentation.
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Affiliation(s)
- Glória Abreu
- Cardiology Department, Braga Hospital, Braga, Portugal.
| | - Pedro Azevedo
- Cardiology Department, Braga Hospital, Braga, Portugal
| | | | | | | | | | | | | | | | - Jorge Marques
- Cardiology Department, Braga Hospital, Braga, Portugal
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Formiga F, Moreno-Gonzalez R, Chivite D, Casado J, Escrihuela-Vidal F, Corbella X. Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization. Rev Port Cardiol 2018; 37:159-165. [PMID: 29501214 DOI: 10.1016/j.repc.2017.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Chronic kidney disease is related to poor outcomes in patients with heart failure (HF). Few studies have assessed whether renal function influences one-year mortality risk in patients admitted for the first time for acute HF. METHODS We reviewed the medical records of all patients aged >50 years admitted within a two-year period for a first episode of decompensated HF. The sample was divided according to the patients' estimated glomerular filtration rate (eGFR) on admission into three groups (eGFR >60, 30-60 and <30 ml/min/1.73 m2). Index admission and one-year all-cause mortality rates were compared between groups using Cox regression analysis. RESULTS A total of 985 patients were included in the study, mean age 78.4±9 years, and with mean admission eGFR of 60.5±26 ml/min/1.73 m2. Of these, 516 (52.3%) patients had eGFR <60 ml/min/1.73 m2. One-year all-cause mortality was 25.4%, with a significant association between worse eGFR category and mortality (p<0.0001). Cox regression analysis assessing eGFR as a categorical variable confirmed this association (HR 1.378; p=0.030), together with older age (HR 1.066; p<0.001), previous diagnosis of hypertension (HR 0.527; p<0.001), and both lower systolic blood pressure (HR 0.993; p=0.009) and higher serum potassium on admission (HR 1.471; p <0.001). CONCLUSIONS Renal impairment is common in HF patients, even at the time of first admission. In this group of HF patients the presence of renal impairment was associated with higher mid-term (one-year) mortality risk.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain.
| | - Rafael Moreno-Gonzalez
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain
| | - David Chivite
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain
| | - Jesús Casado
- Internal Medicine Department, Getafe University Hospital, Madrid, Spain
| | | | - Xavier Corbella
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Catalunya International University, Barcelona, Spain
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Costi LR, Iwamoto HM, Neves DCDO, Caldas CAM. Mortality from systemic erythematosus lupus in Brazil: evaluation of causes according to the government health database. Rev Bras Reumatol Engl Ed 2017; 57:574-582. [PMID: 29032927 DOI: 10.1016/j.rbre.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 05/10/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To characterize the causes of mortality in patients with systemic lupus erythematosus (SLE) in Brazil between 2002 and 2011. METHODS An exploratory ecological study of a time series using data from the Mortality Information System of DATASUS, the Department of the Unified Health System (Brazil's National Health System). RESULTS Brazil's SLE mortality rate was 4.76 deaths/105 inhabitants. The mortality rate was higher in the Midwest, North and Southeast regions than in the country as a whole. There were 6.3% fewer and 4.2% more deaths than expected in the Northeast and Southeast regions, respectively. The mean age at death was 40.7±18 years, and 45.61% of deaths occurred between the ages of 20 and 39. Incidence was highest in women (90.7%) and whites (49.2%). Disorders of the musculoskeletal system and connective tissue were mentioned as an underlying cause of death in 77.5% of cases, and diseases of the circulatory system and infectious and parasitic diseases were also noted in fewer cases. SLE was mentioned as an underlying cause of death in 77% of cases, with no difference between the Brazilian regions (p=0.2058). The main SLE-related causes of death were, sequentially, diseases of the respiratory and circulatory systems and infectious and parasitic diseases. CONCLUSIONS This study identified a need for greater control of risk factors for cardiovascular diseases and a better understanding of the pathogenesis of atherosclerosis in SLE. Infectious causes are still frequent, and management should be improved, especially in the early stages of the disease.
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Ayar Y, Ersoy A, Oksuz MF, Ocakoglu G, Vuruskan BA, Yildiz A, Isiktas E, Oruc A, Celikci S, Arslan I, Sahin AB, Güllülü M. Clinical outcomes and survival in AA amyloidosis patients. Rev Bras Reumatol Engl Ed 2017; 57:535-544. [PMID: 29173691 DOI: 10.1016/j.rbre.2017.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022] Open
Abstract
AIM Amyloid A amyloidosis is a rare complication of chronic inflammatory conditions. Most patients with amyloid A amyloidosis present with nephropathy and it leads to renal failure and death. We studied clinical characteristics and survival in patients with amyloid A amyloidosis. METHODS A total of 81 patients (51 males, 30 females) with renal biopsy proven amyloid A amyloidosis were analyzed retrospectively. The patients were divided into good and poor outcomes groups according to survival results. RESULTS Most of the patients (55.6%) had nephrotic range proteinuria at diagnosis. Most frequent underlying disorders were familial Mediterranean fever (21.2%) and rheumatoid arthritis (10.6%) in the good outcome group and malignancy (20%) in the poor outcome group. Only diastolic blood pressure in the good outcome group and phosphorus level in the poor outcome group was higher. Serum creatinine levels increased after treatment in both groups, while proteinuria in the good outcome group decreased. Increase in serum creatinine and decrease in estimated glomerular filtration rate of the poor outcome group were more significant in the good outcome group. At the time of diagnosis 18.5% and 27.2% of all patients had advanced chronic kidney disease (stage 4 and 5, respectively). Median duration of renal survival was 65±3.54 months. Among all patients, 27.1% were started dialysis treatment during the follow-up period and 7.4% of all patients underwent kidney transplantation. Higher levels of systolic blood pressure [hazard ratios 1.03, 95% confidence interval: 1-1.06, p=0.036], serum creatinine (hazard ratios 1.25, 95% confidence interval: 1.07-1.46, p=0.006) and urinary protein excretion (hazard ratios 1.08, 95% confidence interval: 1.01-1.16, p=0.027) were predictors of end-stage renal disease. Median survival of patients with organ involvement was 50.3±16 months. CONCLUSION Our study indicated that familial Mediterranean fever constituted a large proportion of cases and increased number of patients with idiopathic amyloid A amyloidosis. Additionally, it was observed that patient survival was not affected by different etiological causes in amyloid A amyloidosis.
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Affiliation(s)
- Yavuz Ayar
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey.
| | - Alparslan Ersoy
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey
| | | | - Gokhan Ocakoglu
- Uludağ University Medical Faculty, Department of Biostatistics, Bursa, Turkey
| | | | - Abdülmecit Yildiz
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey
| | - Emel Isiktas
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey
| | - Aysegül Oruc
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey
| | - Sedat Celikci
- Uludağ University Medical Faculty, Department of Internal Medicine, Bursa, Turkey
| | - Ismail Arslan
- Uludağ University Medical Faculty, Department of Internal Medicine, Bursa, Turkey
| | - Ahmet Bilgehan Sahin
- Uludağ University Medical Faculty, Department of Internal Medicine, Bursa, Turkey
| | - Mustafa Güllülü
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey
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Lopes CLS, Pinheiro PP, Barberena LS, Eckert GU. Diabetic ketoacidosis in a pediatric intensive care unit. J Pediatr (Rio J) 2017; 93:179-184. [PMID: 27770618 DOI: 10.1016/j.jped.2016.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the characteristics of children aged 0-14 years diagnosed with diabetic ketoacidosis and compare the following outcomes between children with prior diagnosis of type 1 diabetes mellitus and children without prior diagnosis of type 1 diabetes mellitus length of hospital stay, severity on admission, insulin dosage, time of continuous insulin use, volume of fluids infused during treatment, and complications. METHODS A retrospective descriptive study with review of medical records of patients admitted to the pediatric intensive care unit of a referral hospital from June 2013 to July 2015. The following data regarding 52 admissions were analyzed: age, sex, weight, body surface area, signs, symptoms and severity on admission, blood gas, blood glucose, glycated hemoglobin, serum osmolarity, and index of mortality. The insulin dosage, time of continuous insulin use, volume administered in the expansion phase and in the first 24h, length of stay, and complications such as electrolyte disturbances, hypoglycemia, cerebral edema, and death were compared between the two groups. RESULTS Patients without a previous diagnosis of DM1 were younger at admission, with mean age of 8.4 years (p<0.01), reported more nausea or vomiting, polydipsia and polyuria, and showed more weight loss (p<0.01). This study also observed a higher prevalence of hypokalemia (p<0.01) and longer hospital stay in this group. CONCLUSIONS No differences in severity between groups were observed. The study showed that children without prior diagnosis of type 1 diabetes mellitus were younger at admission, had more hypokalemia during the course of treatment, and had greater length of hospital stay.
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Affiliation(s)
- Clarice L S Lopes
- Hospital da Criança Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil.
| | - Paula Pitta Pinheiro
- Hospital da Criança Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Luzia S Barberena
- Hospital da Criança Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Guilherme U Eckert
- Hospital da Criança Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
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Riyuzo MC, Silveira LVDA, Macedo CS, Fioretto JR. Predictive factors of mortality in pediatric patients with acute renal injury associated with sepsis. J Pediatr (Rio J) 2017; 93:28-34. [PMID: 27379973 DOI: 10.1016/j.jped.2016.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/21/2016] [Accepted: 04/08/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the prognosis factors of children with sepsis and acute kidney injury. METHODS This was a retrospective study of children with sepsis and acute kidney injury that were admitted to the pediatric intensive care unit (PICU) of a tertiary hospital. A multivariate analysis was performed to compare risk factors for mortality. RESULTS Seventy-seven children (47 males) were retrospectively studied, median age of 4 months. Mean length of hospital stay was 7.33±0.16 days, 68.9% of patients received mechanical ventilation, 25.9% had oligo-anuria, and peritoneal dialysis was performed in 42.8%. The pRIFLE criteria were: injury (5.2%) and failure (94.8%), and the staging system criteria were: stage 1 (14.3%), stage 2 (29.9%), and stage 3 (55.8%). The mortality rate was 33.7%. In the multivariate analysis, the risk factors for mortality were PICU length of stay (OR=0.615, SE=0.1377, 95% CI=0.469-0.805, p=0.0004); invasive mechanical ventilation (OR=14.599, SE=1.1178, 95% CI=1.673-133.7564, p=0.0155); need for dialysis (OR=9.714, SE=0.8088, 95% CI=1.990-47.410, p=0.0049), and hypoalbuminemia (OR=10.484, SE=1.1147, 95% CI=1.179-93.200, p=0.035). CONCLUSIONS The risk factors for mortality in children with acute kidney injury were associated with sepsis severity.
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Affiliation(s)
- Marcia C Riyuzo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Pediatria, Botucatu, SP, Brazil.
| | - Liciana V de A Silveira
- Universidade Estadual Paulista (UNESP), Instituto de Biociências de Botucatu, Departamento de Bioestatística, Botucatu, SP, Brazil
| | - Célia S Macedo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Pediatria, Botucatu, SP, Brazil
| | - José R Fioretto
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Pediatria, Botucatu, SP, Brazil
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Rodrigues NCP, Monteiro DLM, Almeida ASD, Barros MBDL, Pereira Neto A, O'Dwyer G, Andrade MKDN, Flynn MB, Lino VTS. Temporal and spatial evolution of maternal and neonatal mortality rates in Brazil, 1997-2012. J Pediatr (Rio J) 2016; 92:567-573. [PMID: 27234038 DOI: 10.1016/j.jped.2016.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/17/2016] [Accepted: 03/23/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Maternal and neonatal mortality are important public health issues in low-income countries. This study evaluated spatial and temporal maternal and neonatal mortality trends in Brazil between 1997 and 2012. METHODS This study employed spatial analysis techniques using death records from the mortality information system. Maternal mortality rates per 100,000 and neonatal mortality rates (early and late) per 1000 live births were calculated by state, region, and period (1997-2000, 2001-2004, 2005-2008, and 2009-2012). Multivariate negative binomial models were used to explain the risk of death. RESULTS The mean Brazilian maternal mortality rate was 55.63/100,000 for the entire 1997-2012 period. The rate fell 10% from 1997-2000 (58.92/100,000) to 2001-2004 (52.77/100,000), but later increased 11% during 2009-2012 (58.69/100,000). Early and late neonatal mortality rates fell 33% (to 7.36/1000) and 21% (to 2.29/1000), respectively, during the 1997-2012 period. Every Brazilian region witnessed a drop in neonatal mortality rates. However, maternal mortality increased in the Northeast, North, and Southeast regions. CONCLUSION Brazil's neonatal mortality rate has improved in recent times, but maternal mortality rates have stagnated, failing to meet the Millennium Development Goals. Public policies and intersectoral efforts may contribute to improvements in these health indicators.
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Affiliation(s)
- Nádia Cristina Pinheiro Rodrigues
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Rio de Janeiro, RJ, Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brazil.
| | - Denise Leite Maia Monteiro
- Universidade do Estado do Rio de Janeiro (UERJ), Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brazil
| | - Andréa Sobral de Almeida
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Rio de Janeiro, RJ, Brazil
| | - Mônica Barros de Lima Barros
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Rio de Janeiro, RJ, Brazil
| | - André Pereira Neto
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Rio de Janeiro, RJ, Brazil
| | - Gisele O'Dwyer
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Rio de Janeiro, RJ, Brazil
| | - Mônica Kramer de Noronha Andrade
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Rio de Janeiro, RJ, Brazil; Instituto Vital Brazil, Centro de Estudo e Pesquisa do Envelhecimento, Niterói, RJ, Brazil
| | - Matthew Brian Flynn
- Georgia Southern University, Department of Sociology & Anthropology, Statesboro, United States
| | - Valéria Teresa Saraiva Lino
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Rio de Janeiro, RJ, Brazil
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Dal'Astra APL, Quirino AV, Caixêta JADS, Avelino MAG. Tracheostomy in childhood: review of the literature on complications and mortality over the last three decades. Braz J Otorhinolaryngol 2016; 83:207-214. [PMID: 27256033 PMCID: PMC9442684 DOI: 10.1016/j.bjorl.2016.04.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Tracheostomy is a procedure with unique characteristics when used on pediatric patients due to the greater technical difficulty and higher morbidity and mortality rates relative to the procedure in adults. In recent decades, there have been significant changes in the medical care available to children, particularly for those who need intensive care. Surgical conditions have also improved, and there has been an advent of new equipment and medications. These advances have brought changes to both tracheostomy indications and tracheostomy complications. OBJECTIVE To perform a review of the articles published over the last three decades on the complications and mortality associated with tracheostomies in children. METHODS Articles were selected from the Cochrane, Latin American and Caribbean Health Sciences Literature, SciELO, National Library of Medicine (Medline Plus), and PubMed online databases. The articles selected had been published between January 1985 and December 2014, and the data was compared using the Chi-square test. RESULTS A total of 3797 articles were chosen, 47 of which were used as the basis for this review. When the three decades were evaluated as a whole, an increase in tracheostomies in male children under one year of age was found. The most common complications during the period analyzed in descending order of frequency were granuloma, infection, and obstruction of the cannula, accidental decannulation, and post-decannulation tracheocutaneous fistula. In the second and third decades of the review, granulomas represented the most common complication; in the first decade of the review, pneumothoraces were the most common. Mortality associated with tracheostomy ranged from 0% to 5.9%, while overall mortality ranged from 2.2% to 59%. In addition, the review included four studies on premature and/or very underweight infants who had undergone tracheostomies; the studies reported evidence of higher mortality in this age group to be largely associated with underlying diseases. CONCLUSION Improved surgical techniques and intensive care, the creation of new medications, and vaccines have all redefined the main complications and the mortality rates of tracheostomy in children. It is a safe procedure that increases chances of survival in those who require the prolonged use of mechanical ventilation.
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Costa CAD, Tonial CT, Garcia PCR. Association between nutritional status and outcomes in critically-ill pediatric patients - a systematic review. J Pediatr (Rio J) 2016; 92:223-9. [PMID: 26854736 DOI: 10.1016/j.jped.2015.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/30/2015] [Accepted: 08/19/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To systematically review the evidence about the impact of nutritional status in critically-ill pediatric patients on the following outcomes during hospitalization in pediatric intensive care units: length of hospital stay, need for mechanical ventilation, and mortality. DATA SOURCE The search was carried out in the following databases: Lilacs (Latin American and Caribbean Health Sciences), MEDLINE (National Library of Medicine United States) and Embase (Elsevier Database). No filters were selected. RESULTS A total of seven relevant articles about the subject were included. The publication period was between 1982 and 2012. All articles assessed the nutritional status of patients on admission at pediatric intensive care units and correlated it to at least one assessed outcome. A methodological quality questionnaire created by the authors was applied, which was based on some references and the researchers' experience. All included studies met the quality criteria, but only four met all the items. CONCLUSION The studies included in this review suggest that nutritional depletion is associated with worse outcomes in pediatric intensive care units. However, studies are scarce and those existing show no methodological homogeneity, especially regarding nutritional status assessment and classification methods. Contemporary and well-designed studies are needed in order to properly assess the association between children's nutritional status and its impact on outcomes of these patients.
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Affiliation(s)
- Caroline A D Costa
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil; Postgraduate Program in Pediatrics and Children's Health, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil.
| | - Cristian T Tonial
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil; Postgraduate Program in Pediatrics and Children's Health, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
| | - Pedro Celiny R Garcia
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil; Postgraduate Program in Pediatrics and Children's Health, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
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Barbosa FT, da Cunha RM, da Silva Ramos FW, de Lima FJ, Rodrigues AK, do Nascimento Galvão AM, de Sousa-Rodrigues CF, Lima PM. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis. Braz J Anesthesiol 2016; 66:183-93. [PMID: 26952228 DOI: 10.1016/j.bjane.2014.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/02/2014] [Accepted: 05/13/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. RESULTS 17 original articles analyzed. Meta-analysis of mortality (RD=-0.01, 95% CI=-0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32-1.95), MI (RR=0.96, 95% CI=0.52-1.79) and LHS (MD=-1.94, 95% CI=-3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50-0.93). ICUS was lower in NA (MD=-2.09, 95% CI=-2.92 to -1.26). CONCLUSION There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.
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Sabarense AP, Lima GO, Silva LML, Viana MB. Characterization of mortality in children with sickle cell disease diagnosed through the Newborn Screening Program. J Pediatr (Rio J) 2015; 91:242-7. [PMID: 25449790 DOI: 10.1016/j.jped.2014.08.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To characterize the deaths of 193 children with sickle cell disease screened by a neonatal program from 1998 to 2012 and contrast the initial years with the final years. METHODS Deaths were identified by active surveillance of children absent to scheduled appointments in Blood Bank Clinical Centers (Hemominas). Clinical and epidemiological data came from death certificates, neonatal screening database, medical records, and family interviews. RESULTS Between 1998 and 2012, 3,617,919 children were screened and 2,591 had sickle cell disease (1:1,400). There were 193 deaths (7.4%): 153 with SS/Sβ(0)-thalassemia, 34 SC and 6 Sβ(+)thalassemia; 76.7% were younger than five years; 78% died in the hospital and 21% at home or in transit. The main causes of death were infection (45%), indeterminate (28%), and acute splenic sequestration (14%). In 46% of death certificates, the term "sickle cell" was not recorded. Seven-year death rate for children born between 1998 and 2005 was 5.43% versus 5.12% for those born between 2005 and 2012 (p = 0.72). Medical care was provided to 75% of children; 24% were unassisted. Medical care was provided within 6 hours of symptom onset in only half of the interviewed cases. In 40.5% of cases, death occurred within the first 24 hours. Low family income was recorded in 90% of cases, and illiteracy in 5%. CONCLUSIONS Although comprehensive and effective, neonatal screening for sickle cell disease was not sufficient to significantly reduce mortality in a newborn screening program. Economic and social development and increase of the knowledge on sickle cell disease among health professionals and family are needed to overcome excessive mortality.
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Affiliation(s)
- Alessandra P Sabarense
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Gabriella O Lima
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Lívia M L Silva
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Marcos Borato Viana
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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Grandi C, Tapia JL, Cardoso VC. Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study. J Pediatr (Rio J) 2015; 91:234-41. [PMID: 25433204 DOI: 10.1016/j.jped.2014.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). METHODS This was a cohort study with retrospective data collection (2001-2010, n=11.991) from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. RESULTS The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p=0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). CONCLUSIONS VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC.
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Affiliation(s)
- Carlos Grandi
- Department of Pediatrics, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Jose L Tapia
- Department of Pediatrics, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Viviane C Cardoso
- Ribeirão Preto Medical School, Universidade de São Paulo, São Paulo, Brazil
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Barbosa FT, de Sousa Rodrigues CF, Castro AA, da Cunha RM, Barbosa TRBW. Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery? Braz J Anesthesiol 2015; 66:304-9. [PMID: 27108829 DOI: 10.1016/j.bjane.2013.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/16/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of neuraxial anesthesia in cardiac surgery is recent, but the hemodynamic effects of local anesthetics and anticoagulation can result in risk to patients. OBJECTIVE To review the benefits of neuraxial anesthesia in cardiac surgery for CABG through a systematic review of systematic reviews. CONTENT The search was performed in Pubmed (January 1966 to December 2012), Embase (1974 to December 2012), The Cochrane Library (volume 10, 2012) and Lilacs (1982 to December 2012) databases, in search of articles of systematic reviews. The following variables: mortality, myocardial infarction, stroke, in-hospital length of stay, arrhythmias and epidural hematoma were analyzed. CONCLUSIONS The use of neuraxial anesthesia in cardiac surgery remains controversial. The greatest benefit found by this review was the possibility of reducing postoperative arrhythmias, but this result was contradictory among the identified findings. The results of findings regarding mortality, myocardial infarction, stroke and in-hospital length of stay did not show greater efficacy of neuraxial anesthesia.
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Fonseca JGD, Ferreira AR. [Application of the Pediatric Index of Mortality 2 in pediatric patients with complex chronic conditions]. J Pediatr (Rio J) 2014; 90:506-11. [PMID: 24814186 DOI: 10.1016/j.jped.2014.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the performance of the Pediatric Index of Mortality 2 (PIM2) in a pediatric intensive care unit (PICU) with a high prevalence of patients with complex chronic conditions (CCCs), and compare the performance between patients with and without CCCs. METHODS A prospective cohort study was conducted in a PICU in Brazil, with patients admitted between 2009 and 2011. The performance was evaluated through discrimination and calibration. Discrimination was assessed by calculating the area under the ROC curve, and calibration was determined using the Hosmer-Lemeshow goodness-of-fit test. RESULTS A total of 677 patients were included in the study, of which 83.9% had a CCC. Overall mortality was 9.7%, with a trend of higher mortality among patients with CCCs when compared to patients without CCCs (10.3% vs. 6.4%, p = 0.27), but with no difference in the mean probability of death estimated by PIM2 (5.9% vs. 5.6%, p = 0.5). Discrimination was considered adequate in the general population (0.840) and in patients with and without CCCs (0.826 and 0.944). Calibration was considered inadequate in the general population and in patients with CCCs (p < 0.0001 and p < 0.0001), but it was considered adequate in patients without CCCs (p = 0.527). CONCLUSIONS PIM2 showed poor performance in patients with CCCs and in the general population. This result may be secondary to differences in the characteristics between the study samples (high prevalence of patients with CCCs); the performance of the PIM2 should not be ruled out.
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Affiliation(s)
- Jaisson G da Fonseca
- Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| | - Alexandre R Ferreira
- Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Ferreira CH, Carmona F, Martinez FE. Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns. J Pediatr (Rio J) 2014; 90:316-22. [PMID: 24606947 DOI: 10.1016/j.jped.2013.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/06/2013] [Accepted: 10/07/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES to determine the prevalence of pulmonary hemorrhage in newborns and evaluate the associated risk factors and outcomes. METHODS this was a retrospective case-control study involving 67 newborns who met the criteria for pulmonary hemorrhage. A control was selected for each case: the next-born child of the same gender, similar weight (± 200g) and gestational age (± 1 week), with no previous pulmonary hemorrhage and no malformation diagnosis. Factors previous to pulmonary hemorrhage onset, as well as aspects associated to the condition, were assessed. RESULTS the prevalence was 6.7 for 1,000 live births, and the rates observed were: 8% among newborns <1,500g, and 11% among newborns <1,000g. Intubation in the delivery room (OR=7.16), SNAPPE II (OR=2.97), surfactant use (OR=3.7), and blood components used previously to pulmonary hemorrhage onset (OR=5.91) were associated with pulmonary hemorrhage. In the multivariate logistic regression model, only intubation in delivery room and previous use of blood components maintained the association. Children with pulmonary hemorrhage had higher mortality (OR=7.24). Among the survivors, the length of stay (p ≤ 0.01) and mechanical ventilation time were longer (OR=25.6), and oxygen use at 36 weeks of corrected age was higher (OR=7.67). CONCLUSIONS pulmonary hemorrhage is more prevalent in premature newborns, and is associated with intubation in the delivery room and previous use of blood components, leading to high mortality and worse clinical evolution.
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Affiliation(s)
- Cristina Helena Ferreira
- Section of Neonatology of Hospital das Clínicas de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
| | - Fábio Carmona
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Francisco Eulógio Martinez
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
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Hernandez-Trejo M, Herrera-Gonzalez NE, Escobedo-Guerra MR, Haro-Cruz MDJD, Moreno-Verduzco ER, Lopez-Hurtado M, Guerra-Infante FM. Reporting detection of Chlamydia trachomatis DNA in tissues of neonatal death cases. J Pediatr (Rio J) 2014; 90:182-9. [PMID: 24184305 DOI: 10.1016/j.jped.2013.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/07/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE to determine whether C. trachomatis was present in neonates with infection, but without an isolated pathogen, who died during the first week of life. METHODS early neonatal death cases whose causes of death had been previously adjudicated by the institutional mortality committee were randomly selected. End-point and real-time polymerase chain reaction of the C. trachomatis omp1 gene was used to blindly identify the presence of chlamydial DNA in the paraffinized samples of five organs (from authorized autopsies) of each of the dead neonates. Additionally, differential diagnoses were conducted by amplifying a fragment of the 16S rRNA of Mycoplasma spp. RESULTS in five cases (35.7%), C. trachomatis DNA was found in one or more organs. Severe neonatal infection was present in three cases; one of them corresponded to genotype D of C. trachomatis. Interestingly, another case fulfilled the same criteria but had a positive polymerase chain reaction for Mycoplasma hominis, a pathogen known to produce sepsis in newborns. CONCLUSION the use of molecular biology techniques in these cases of early infant mortality demonstrated that C. trachomatis could play a role in the development of severe infection and in early neonatal death, similarly to that observed with Mycoplasma hominis. Further study is required to determine the pathogenesis of this perinatal infection.
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Affiliation(s)
- Maria Hernandez-Trejo
- Department of Neurobiology of Development, Instituto Nacional de Perinatología, DF, Mexico; School of Medicine, Instituto Politécnico Nacional, DF, Mexico
| | | | | | | | | | | | - Fernando M Guerra-Infante
- National School of Biological Sciences, Instituto Politécnico Nacional, DF, Mexico; Department of Infectology, Instituto Nacional de Perinatología, DF, Mexico.
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Orlandini M, Feier FH, Jaeger B, Kieling C, Vieira SG, Zanotelli ML. Frequency of and factors associated with vascular complications after pediatric liver transplantation. J Pediatr (Rio J) 2014; 90:169-75. [PMID: 24370174 DOI: 10.1016/j.jped.2013.08.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/19/2013] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE to evaluate the frequency and factors associated with vascular complications after pediatric liver transplantation. METHOD risk factors were evaluated in 99 patients under 18 years of age with chronic liver disease who underwent deceased donor liver transplantation (DDLT) between March of 1995 and November of 2009 at the Hospital de Clínicas de Porto Alegre, Brazil. The variables analyzed included donor and recipient age, gender, and weight; indication for transplant; PELD/MELD scores; technical aspects; postoperative vascular complications; and survival. RESULTS vascular complications occurred in 19 patients (19%). Arterial events were most common, occurred earlier in the postoperative period, and were associated with high graft loss and mortality rates. In the multivariate analysis, the following factors were identified: portal vein diameter ≤ 3mm, donor-to-recipient body weight ratio (DRWR), prolonged ischemic time, and use of arterial grafts. CONCLUSION the choice of treatment depends on the timing of diagnosis; however, in this study, surgical revision or correction produced worse outcomes than percutaneous angioplasty. The reduction of risk factors and early detection of vascular complications are key elements to a successful transplantation.
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Affiliation(s)
- Mariana Orlandini
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Flávia Heinz Feier
- Pediatric Liver Transplantation Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Brunna Jaeger
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Carlos Kieling
- Pediatric Hepatology and Liver Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Sandra Gonçalves Vieira
- Pediatric Hepatology and Liver Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Maria Lucia Zanotelli
- Pediatric Liver Transplantation Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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García GM, Miúdo V, Manuel Lopes CDGA, Vassuelela Gomes J. Characterization of patients aged 45 or under admitted with hypertensive emergencies in the Hospital do Prenda. Rev Port Cardiol 2014; 33:19-25. [PMID: 24418685 DOI: 10.1016/j.repc.2013.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/25/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The incidence and prevalence of hypertensive emergency have been little addressed in the literature. However, over the last decade increasing numbers of young patients with different forms of hypertensive crisis have been observed in emergency departments. We performed this study to ascertain the clinical and epidemiological characteristics of patients aged ≤ 45 years admitted with a diagnosis of hypertensive emergency. METHODS We conducted an observational, descriptive, cross-sectional prospective study of 123 patients hospitalized for hypertensive emergency in the Hospital do Prenda, Luanda, between May 2011 and June 2012. RESULTS Mean age was 36.62 ± 5.49 years, and most were male (52.85%). The main risk factor was hypertension (65.9%), with 17.3% complying with therapy. The most frequent forms of presentation were hypertensive encephalopathy and hemorrhagic stroke (9.8% and 82.1%, respectively). The main drugs used were diuretics, angiotensin-converting enzyme inhibitors and calcium channel blockers. Mortality during hospitalization was 25.2% (31 patients), hemorrhagic stroke being the most common cause. There was a significant association between age and in-hospital mortality. CONCLUSIONS Of patients admitted with hypertensive emergency, 30.1% were aged ≤ 45 years. Hemorrhagic stroke was the most common presentation. There was a significant relationship between mode of presentation, age and in-hospital mortality.
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Affiliation(s)
| | - Venâncio Miúdo
- Serviço de Cardiologia, Hospital do Prenda, Luanda, Angola
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Hentges CR, Silveira RC, Procianoy RS, Carvalho CG, Filipouski GR, Fuentefria RN, Marquezotti F, Terrazan AC. Association of late-onset neonatal sepsis with late neurodevelopment in the first two years of life of preterm infants with very low birth weight. J Pediatr (Rio J) 2014; 90:50-7. [PMID: 24148798 DOI: 10.1016/j.jped.2013.10.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/28/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To establish the influence of late-onset sepsis on neurodevelopment of preterm infants with very low birth weight (VLBW), according to the etiologic agent. METHOD This was a cohort of newborns with birth weight<1,500 g and gestational age less than 32 weeks, admitted to the institutional intensive care unit (ICU) with up to 48 hours of life, and followed-up at the outpatient follow-up clinic for preterm infants with VLBW until 2 years of corrected age. EXCLUSION CRITERIA death within the first 72 hours of life, congenital malformations and genetic syndromes, children with congenital infection by the human immunodeficiency virus (HIV), congenital infection (STORCH), presence of early-onset sepsis and cases with more than one pathogen growth in blood cultures. Septic and non-septic infants were compared regarding neonatal outcomes and mortality. Neurodevelopment was assessed using the Bayley Scale (BSDI-II) at 18 to 24 months of corrected age. RESULTS 411 preterm infants with VLBW were eligible; the mean gestational age was 29 ± 2.2 weeks and mean birth weight was 1,041 ± 281 grams. Late-onset sepsis occurred in 94 preterm infants with VLBW (22.8%). VLBW infants with Gram-positive infection showed motor deficit when compared to the non-septic group, 68.8% vs. 29.3%, respectively (OR 6; 1.6-21.8, p=0.006); the cognitive development was similar between the groups. The overall mortality rate from infection was 26.7%; considering the pathogens, the rates were 18.7% for coagulase-negative Staphylococcus, 21.8% for Gram-positive bacteria, and 50% for Gram-negative bacteria and fungi. CONCLUSION Neonatal sepsis has a significant influence on late neurodevelopment at 2 years of corrected age in preterm infants with VLBW, and Gram-positive infections are associated with motor deficit.
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Affiliation(s)
- Cláudia Regina Hentges
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clinícas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Rita C Silveira
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clinícas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Renato Soibelmann Procianoy
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clinícas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Clarissa Gutierrez Carvalho
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clinícas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Fernanda Marquezotti
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ana Carolina Terrazan
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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