RESUMO
Cardiac troponin-I (cTnI) is a biomarker of myocardial injury with implications for clinical outcomes. May other contributing factors that could affect outcomes have not been uniformly considered in pediatric studies. We hypothesized that there is an association between admission serum cTnI and outcomes in critically ill children taking into account the magnitude of the acute systemic inflammatory response syndrome (SIRS), serum lactate concentrations, and nutritional status. Second, we tested for potential factors associated with elevated serum cTnI. This was a prospective cohort study in 104 children (median age: 21.3 months) consecutively admitted to a pediatric intensive care unit (PICU) of a teaching hospital with SIRS and without previous chronic diseases. Primary outcome variables were PICU-free days, ventilator-free days, and 30-day mortality. Exposure variables were serum cTnI concentration on admission, revised pediatric index of mortality (PIM2), pediatric logistic organ dysfunction (PELOD-2), hypotensive shock, C-reactive protein, procalcitonin, and serum lactate on admission, and malnutrition. Elevated cTnI (>0.01 µg/L) was observed in 24% of patients, which was associated with the reduction of ventilator-free days (ß coefficient = - 4.97; 95% confidence interval [CI]: -8.03; -1.91) and PICU-free days (ß coefficient = - 5.76; 95% CI: -8.97; -2.55). All patients who died had elevated serum cTnI. The increase of 0.1 µg/L in cTnI concentration resulted in an elevation of 2 points in the oxygenation index (ß coefficient = 2.0; 95% CI: 1.22; 2.78, p < 0.001). The PIM2 score, hypotensive shock in the first 24 hours, and serum lactate were independently associated with elevated cTnI on admission. We conclude that elevated serum cTnI on admission is independently associated with adverse outcomes in children with SIRS and without associated chronic diseases.
RESUMO
Listeria monocytogenes es una bacteria grampositiva, considerada oportunista, que produce enfermedad en huéspedes susceptibles y excepcionalmente en pacientes inmunocompetentes. Se incluye dentro de las enfermedades trasmitidas por alimentos (ETA). Su importancia radica en la dificultad diagnóstica, la alta mortalidad pese a la sensibilidad de la bacteria a la ampicilina, y a las medidas de prevención que pueden evitar la transmisión al hombre. Presentamos el caso clínico de una niña de 9 años previamente sana que cursó una infección grave y de evolución fatal.
Assuntos
Humanos , Feminino , Criança , Meningite por Listeria/diagnóstico , Doenças Transmitidas por Alimentos , Doença Catastrófica , Meningite por Listeria/tratamento farmacológicoRESUMO
La endocarditis infecciosa es una enfermedad poco frecuente en pediatría pero con importante morbimortalidad. Si bien existen grupos de riesgo bien definidos puede presentarse en niños sin cardiopatía subyacente e inmunocompetentes, en quienes la etiología estafilocócica es la más frecuente y el diagnóstico continúa siendo un desafío. Presentamos el caso de un niño de 2 años, previamente sano, con una endocarditis a Staphylococcus aureus meticilino sensible de presentación no usual.
Assuntos
Humanos , Masculino , Pré-Escolar , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Infecções Estafilocócicas/complicações , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/etiologia , Embolia Intracraniana/etiologia , Hemorragia Putaminal/etiologia , Hemorragia Putaminal/terapiaRESUMO
OBJECTIVE: The purpose of this study was to evaluate the bond strength of three different ceramic brands with two different ceramic surfaces (glazed and deglazed), with and without silane application. METHODOLOGY: Using the three different ceramics (Empress 2, Finesse, and Ceramco II), two metallic brackets were bonded to each sample, one with the adhesive system and the other one with a silane application. The samples were thermocycled, and then the debonding tests were performed with the Instron Universal Testing Machine. All the results were statistically analyzed with a three-way analysis of variance (ANOVA) test. RESULTS: The three-way ANOVA (brand, ceramic surface, with/without silane) indicated significant differences among them (p < 0.05). ANOVA showed that the greatest bond strength value (megapascals, MPa) was for Empress 2 deglazed with the silane application (8.873 MPa), followed by Finesse glazed with the silane application (7.072 MPa). CONCLUSION: The ceramic surface has a direct effect on adhesion. Therefore, Empress 2 deglazed achieved the greatest value in bond strength. To achieve the ideal values of 6-10 MPa, applying silane to the ceramic surface before bonding the brackets is recommended, even though silane can damage the ceramic surface.