RESUMO
BACKGROUND: Persistent inflammation, immunosuppression and catabolism syndrome (PICS) has been described in critically ill adults and may contribute to unfavourable outcomes. The present study aimed to describe and characterise PICS in critically ill children (PICS-ped) and to verify its association with clinical outcomes. METHODS: A prospective longitudinal study was conducted in a paediatric intensive care unit (PICU) with children aged between 3 months and 15 years. PICS-ped, based on adult definition, was described. PICS-ped was defined as PICU length of stay >14 days; C-reactive protein > 10.0 mg L-1 ; lymphocytes <25%; and any reduction of mid-upper arm circumference Z-score. Clinical, demographic, nutritional status, nutrition therapy parameters and clinical outcomes were assessed. Statistical analysis comprised Mann-Whitney and Fisher's chi-squared tests, as well as logistic and Cox regression. P < 0.05 was considered statistically significant. RESULTS: In total, 153 children were included, with a median age of 51.7 months (interquartile range 15.6-123.4 months), and 60.8% male. The mortality rate was 10.5%. The prevalence of PICS-ped was 4.6%. Days using vasoactive drugs and days using antibiotics were associated with PICS-ped. PICS-ped was associated with mortality in crude (odds ratio = 6.67; P = 0.013) and adjusted analysis (odds ratio = 7.14; P = 0.017). PICS-ped was also associated with PICU and hospital length of stay, as well as duration of mechanical ventilation. Similar results were found in a subset of critically ill children who required mechanical ventilation for more than 48 h. CONCLUSIONS: Children with PICS-ped required antibiotics or vasoactive drugs for a longer period. PICS-ped was associated with poor clinical outcomes in critically ill children. More studies are needed to properly define PICS-ped for this population.
Assuntos
Estado Terminal , Terapia de Imunossupressão , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Inflamação , Tempo de Internação , Estudos Longitudinais , Masculino , Estudos ProspectivosRESUMO
During a routine ultrasound study on a fetus at 21 weeks, nuchal edema was noted. At 21 weeks, repeat ultrasound study at our unit showed scalp and neck edema and a femur length/biparietal diameter ratio below the mean. Transabdominal chorionic villus sampling identified a 48.XYY, +21 chromosome constitution. The fetus had normal internal/external genitalia and signs of Down syndrome.
Assuntos
Síndrome de Down/diagnóstico por imagem , Ultrassonografia Pré-Natal , Cariótipo XYY , Feminino , Humanos , Recém-Nascido , Masculino , Pescoço/anormalidades , Pescoço/diagnóstico por imagem , Gravidez , Segundo Trimestre da Gravidez , Couro Cabeludo/anormalidades , Couro Cabeludo/diagnóstico por imagemRESUMO
Realizamos uma ultra-sonografia de rotina durante a 24ª semana de gestaçäo de uma primipara de 22 anos, demonstrando-se uma anomalia do formato do crânio fetal. Repetimos a ultrasonografia na 26ª semana tendo sido confirmado um estreitamento na fossa anterior do crânio e um espinha bífica na regiäo lombro-sacra. As duas anomalias foram confirmadas no estudo anatomopatológico do feto. Ressaltamos a importância do sinal ultra-sonográfico descrito uma vez que, no Brasil, as dosagens de alfafetoproteína, quer no líquido amniótico ou no soro materno, exibem padröes de confiabilidade para fins de diagnóstico pré-natal
Assuntos
Humanos , Feto/anormalidades , Diagnóstico Pré-Natal , Disrafismo Espinal/diagnóstico , Meningomielocele/diagnóstico , UltrassonografiaRESUMO
E relatado um caso de carcinoma de celulas claras do endometrio em jovem nulipara de raca negra, fato interessante, visto se tratar de patologia que acomete na maioria das vezes pacientes de 5a. e 6a. decadas e de raca branca. A terapeutica cirurgica adotada na epoca em que a paciente foi atendida foi mais agressiva em virtude de que o conceito entao vigente era de que o carcinoma de celulas claras do endometrio apresentava maior agressividade e maior mortalidade, o que ja nao prevalece nos trabalhos mais modernos