RESUMO
INTRODUCTION: Postextubation dysphagia (PED) is reported mainly in adults and is associated with poor outcomes. However, data on pediatric intensive care unit (PICU) patients are scarce. We aimed to assess the incidence, risk factors, and outcomes associated with PED in a PICU population. METHODS: Between 2019 and 2021, we conducted a prospective, observational cohort study of patients aged 1 month to 15 years. Within 24 h after extubation, a speech-language pathologist routinely screened all consecutive patients receiving mechanical ventilation (>24 h) for dysphagia. A Functional Oral Intake Scale (FOIS) score of less than 6 indicated dysphagia. RESULTS: A total of 161 patients were included, with a PED incidence of 69%. After adjusting for confounding variables, five variables were significantly associated with PED (odds ratio; 95% confidence interval): age <24 months (4.84; 1.5-15.60), neurological comorbidities (7.47; 1.36-40.96), iatrogenic withdrawal syndrome (5.52; 1.31-23.14), use of neuromuscular blocking agents (4.19; 1.18-14.82), and duration of intubation >72 h (3.22; 1.08-9.64). Dysphagia was significantly associated with longer PICU and hospital stays and a longer delay to oral feeding than patients without PED, 14 versus 7.5 days, 21 versus 15 days, and 6 versus 1 day, respectively. Ten participants (9%) failed to resume total oral intake at hospital discharge. CONCLUSIONS: These findings indicate that PED is highly prevalent in children and associated with adverse patient outcomes. Identifying a core of risk factors might improve prompt recognition of patients at risk for PED and implement preventive approaches and early interventions.
Assuntos
Transtornos de Deglutição , Adulto , Humanos , Criança , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Estado Terminal , Estudos Prospectivos , Extubação/efeitos adversos , Respiração Artificial/efeitos adversosRESUMO
The activity concentrations of 40K, 210Pb, 210Po, 226Ra, 228Ra, 228Th, 230Th, 232Th, 234U, and 238U were determined in 82 food samples, grouped into 20 food groups according to the Brazilian Total Diet, which reflects the dietary habits of a population, for the rural and urban areas of Poços de Caldas city, a High Background Radiation Area. The highest activity concentration found in the food samples was due to 40K being present in all types of food. Among the other radionuclides, high activity concentrations were found for 210Pb in beans and salt, 210Po in fish, 226Ra and 228Ra in nuts and seeds. The main food groups that contributed most to the effective dose, in urban and rural regions, were beans and beverages. The effective doses, due to the ingestion of the analysed food groups, were of 0.44 and 0.60 mSv y-1 and the lifetime cancer risks were 1.6 × 10-3 and 2.3 × 10-3 for the urban and rural Poços de Caldas population, respectively.
Assuntos
Radiação de Fundo , Monitoramento de Radiação , Brasil , Dieta , Radioisótopos/análiseRESUMO
PURPOSE: Compare outcomes of adult patients admitted to ICU- length of ICU stay, length of mechanical ventilation (MV), and time until extubation- according to the use of propofol versus midazolam. METHODS: We searched MEDLINE, EMBASE, LILACS, and Cochrane databases to retrieve RCTs that compared propofol and midazolam used as sedatives in adult ICU patients. We applied a random-effects, meta-analytic model in all calculations. We applied the Cochrane collaboration tool and GRADE. We separated patients into two groups: acute surgical patients (hospitalization up to 24 h) and critically-ill patients (hospitalization over 24 h and whose articles mostly mix surgical, medical and trauma patients). RESULTS: Globally, propofol was associated with a reduced MV time of 4.46 h (MD: -4.46 [95% CI -7.51 to -1.42] p = 0.004, I2 = 63%, 6 studies) and extubation time of 7.95 h (MD: -7.95 [95% CI -9.86 to -6.03] p < 0.00001, I2 = 98%, 16 studies). Acute surgical patients sedation with propofol compared to midazolam was associated with a reduced ICU stay of 5.07 h (MD: -5.07 [95% CI -8.68 to -1.45] p = 0.006, I2 = 41%, 5 studies), MV time of 4.28 h (MD: -4.28; [95% CI -4.62 to -3.94] p < 0.0001, I2 = 0%, 3 studies), extubation time of 1.92 h (MD: -1.92; [95% CI -2.71 to -1.13] p = 0.00001, I2 = 89%, 9 studies). In critically-ill patients sedation with propofol compared to midazolam was associated with a reduced extubation time of 32.68 h (MD: -32.68 [95% CI -48.37 to -16.98] p = 0.0001, I2 = 97%, 9 studies). GRADE was very low for all outcomes. CONCLUSIONS: Sedation with propofol compared to midazolam is associated with improved clinical outcomes in ICU, with reduced ICU stay MV time and extubation time in acute surgical patients and reduced extubation time in critically-ill patients.
Assuntos
Midazolam , Propofol , Adulto , Cuidados Críticos , Humanos , Hipnóticos e Sedativos , Unidades de Terapia Intensiva , Respiração ArtificialRESUMO
Ants frequently interact with fleshy fruits on the ground of tropical forests. This interaction is regarded as mutualistic because seeds benefit from enhanced germination and dispersal to nutrient-rich microsites, whereas ants benefit from consuming the nutritious pulp/aril. Considering that the process of deforestation affects many attributes of the ecosystem such as species abundance and composition, and interspecific interactions, we asked whether the interaction between ants and fallen fleshy fruits in the Brazilian Atlantic forest differs between human-created fragments and undisturbed forests. We controlled diaspore type and quantity by using synthetic fruits (a plastic 'seed' covered by a lipid-rich 'pulp'), which were comparable to lipid-rich fruits. Eight independent areas (four undisturbed forests, and four disturbed forest fragments) were used in the field experiment, in which we recorded the attracted ant species, ant behaviour, and fruit removal distance. Fruits in undisturbed forest sites attracted a higher number of species than those in disturbed forests. Moreover, the occurrence of large, fruit-carrying ponerine ants (Pachycondyla, Odontomachus; 1.1 to 1.4 cm) was higher in undisturbed forests. Large species (≥3 mm) of Pheidole (Myrmicinae), also able to remove fruits, did not differ between forest types. Following these changes in species occurrence, fruit displacement was more frequent in undisturbed than in disturbed forests. Moreover, displacement distances were also greater in the undisturbed forests. Our data suggest that fallen fleshy fruits interacting with ants face different fates depending on the conservation status of the forest. Together with the severe loss of their primary dispersers in human-disturbed tropical forest sites, vertebrate-dispersed fruits may also be deprived of potential ant-derived benefits in these habitats due to shifts in the composition of interacting ant species. Our data illustrate the use of synthetic fruits to better understand the ecology of ant-fruit interactions in variable ecological settings, including human-disturbed landscapes.
Assuntos
Formigas/fisiologia , Biomimética , Conservação dos Recursos Naturais , Frutas , Chuva , Árvores/fisiologia , Animais , Oceano Atlântico , BrasilRESUMO
The concentration of (238)U, (232)Th, (230)Th, (226)Ra, (228)Ra and (210)Pb were determined in samples of Peperomia pellucida and in the surrounding soil, by alpha spectrometry and gross alpha and beta counting. The radionuclide activity concentrations ranged from 4.3 to 38 Bq kg(-1), 1.7-124 Bq kg(-1), 2.1-38 Bq kg(-1), 8.5-37 Bq kg(-1), 3.2-46 Bq kg(-1), 39-93 Bq kg(-1), respectively. In the plant extractions and infusions as used for consumption, the mean recoveries were from 23% to 60% in maceration and 24-75% in infusion.
Assuntos
Peperomia , Radioisótopos/análise , Poluentes Radioativos do Solo/análise , Radiação de Fundo , Brasil , Componentes Aéreos da Planta/química , Raízes de Plantas/química , Plantas Medicinais , Monitoramento de Radiação , RadioatividadeRESUMO
The search for factors shaping leaf-litter ant communities has received particular attention due to the essential role of these insects in many ecological processes. Here, we aimed to investigate how the number of leaves and leaf morphotypes affect the litter-ant species density at forest edge and interior in an Atlantic Forest remnant in the state of Alagoas, Brazil. This study was developed based on 28 litter plots (1m² each), 14 in the forest interior and 14 in the forest edge. As we early expected, ant species density increased with increasing both the number of leaves and the number of leaf morphotypes, but this result was clearly influenced by plot location. Contrasting with the forest interior, ant species density did not increase as the number of leaves increased in the forest edge. Possibly, factors such as plant species richness, vegetation structure and environmental conditions affect ant species density as well as promote a patchy distribution of species in ant communities along the edge-to-interior gradient. Our findings suggest that edge-affected forests present more simplified ant communities, with different factors shaping its structure. We encourage future studies to include leaf litter heterogeneity as one of the explanatory variables investigated.
Assuntos
Formigas , Ecossistema , Folhas de Planta , Animais , Formigas/classificação , Brasil , SoloRESUMO
Ten sediment core samples with lengths ranging from 35 to 100 cm were collected in the Baixada Santista region and analyzed to determine As, Br, Co, Cr, Cs, Fe, Rb, Sb, Ta, Th, U, Zn and rare earths (Sc, Ce, Eu, La, Lu, Nd, Sm, Tb and Yb) level concentrations using instrumental neutron activation analysis (INAA). The studied region is located in the southeastern coast of São Paulo State and is comprised of a densely urbanized area, the largest industrial complex of the country, with a predominance of petrochemical and fertilizer plants. It is also home to Brazil's most important and busiest port. The conclusions found that the As, La, Sm, Ne, Ce, Eu, Hf, Ta, Th, and U elements have a high background level in the region and that Fe and Zn were the main indicators of anthropogenic contribution in the sediments.
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Sedimentos Geológicos/química , Metais/análise , Poluentes Químicos da Água/análise , Brasil , Monitoramento Ambiental , Poluição Química da Água/estatística & dados numéricosRESUMO
BACKGROUND: Neuromuscular blocking agents (NMBA) are commonly administered to critically ill children in pediatric intensive care units (PICU) in the USA and Europe. Although NMBA are frequently used in PICU patients, their role in the PICU setting has not yet been clearly defined. The aim of this study was to describe the sustained administration of NMBA and its impact on outcome of PICU patients. METHODS: A 3-year retrospective cohort study was conducted to compare mechanically-ventilated patients who received NMBA for at least 12 h with patients who did not (control group). RESULTS: A total of 317 consecutive patients were ventilated over 3473 days. Patients were similar in age, weight and severity scores. Thirty-four children (10.7%) received NMBA. Compared with controls, the neuromuscular blockade (NMB) group had a longer duration of mechanical ventilation (13.7 vs 5.5 days, P= 0.000), longer PICU stay (20 vs 11 days, P= 0.000) and increased occurrence of ventilator-associated pneumonia (6.6 vs 4.1/1000 ventilator days, P= 0.010). The NMB use was not associated with higher mortality (8.8% vs 17.6%, P= 0.287) or longer hospital stay (30.5 vs 23 days, P= 0.117). CONCLUSION: Although the use of NMBA was not associated with greater mortality, we found that sustained use of NMBA is associated with prolonged mechanical ventilation, longer PICU stay and higher incidence of ventilator-associated pneumonia when compared with controls. Larger studies are necessary to confirm these findings.
Assuntos
Bloqueio Neuromuscular/efeitos adversos , Oxigênio/sangue , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Estudos de Casos e Controles , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Unidades de Terapia Intensiva Pediátrica , Estimativa de Kaplan-Meier , Tempo de Internação , Modelos Logísticos , Masculino , Bloqueio Neuromuscular/métodos , Prognóstico , Valores de Referência , Respiração Artificial/mortalidade , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , Estatísticas não Paramétricas , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Leaf-cutting ants (Atta spp.) have become a topical issue in Neotropical ecology, particularly because they are reaching hyper-abundance due to escalating levels of fragmentation in recent years. Yet, despite intensive research on their role as dominant herbivores, there is still insufficient documentation on the impacts of their large, long-lived nests on plant assemblage structure and ecosystem functioning. Our study aimed at investigating the magnitude, nature, and spatial extent of nest influence by assessing 11 attributes of ant nest, canopy structure, light environment and sapling assemblage for 20 colonies in four plots along nest-understorey gradients in a large remnant of Atlantic forest. We also monitored the performance of seeds and seedlings of Chrysophyllum viride, an abundant shade-tolerant species. Previously unrecognized canopy gaps above ant nests (0.04-87.9 m(2)) occurred in 95% of all colonies surveyed. Overall, canopy openness and light availability at least doubled in ant nest plots compared with distant understorey plots. These drastic changes in the light environment paralleled those in plant assemblage: sapling density almost tripled (mean +/- SE: 0.42 +/- 0.1 saplings m(-2)) and sapling species richness doubled (0.16 +/- 0.02 species m(-2)) in distant plots, as did shade-tolerant species. After a 1-year period, only 33 +/- 15.6% of the seeds germinated and all seedlings died on nests, whereas seed germination reached 68 +/- 5.1% in distant plots and 66.4 +/- 7.6% of their seedlings survived after 12 months. Therefore, plot location was the most significant explanatory variable for predictable and conspicuous changes in the light environment and structure of sapling assemblages. Our findings greatly extend knowledge on the role played by leaf-cutting ants as ecosystem engineers by demonstrating that ant nest-mediated disturbance promotes environmental modifications in tens of meters around nests and is thus, strong enough to drive plant recruitment and consequently alter both the floristic and functional signature of plant assemblages.
Assuntos
Formigas/fisiologia , Comportamento de Nidação , Sapotaceae/fisiologia , Árvores , Animais , Comportamento Animal , Ecossistema , Modelos LinearesRESUMO
BACKGROUND: A higher frequency of nocturnal gastroesophageal reflux (GER) in adult patients with respiratory symptoms has been demonstrated. The aim of this study was to determine the prevalence of nocturnal GER by using prolonged intraesophageal pH monitoring and compare it with spirometry results in children with persistent asthma. METHODS: Thirty-eight patients with persistent asthma for at least 2 years were studied. Gastrointestinal symptoms suggestive of GER were considered as regurgitation, heartburn, and abdominal pain. All patients underwent prolonged intraesophageal pH study and spirometry. GER was considered positive when a reflux index (RI) was higher than 5%. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), forced mid-expiratory flow rate (FEF(25-75%)), and FEV(1)/FVC ratio were measured. RESULTS: Median age was 10 years of age (range 5 to 15) and 58% were male; GER prevalence was 47.3%. Median (range) of reflux index during supine and upright periods from GER patients were, respectively, 8.7% (3.2 to 23.6) and 10.5% (5.2 to 15.0) (p = 0.913), and only FEF(25-75%) was below the predicted value: 54.5% (39.4 to 96.9). Reflux index was not significantly correlated with FVC, FEV(1) and FEF(25-75%). CONCLUSIONS: A high prevalence of GER was found in children and adolescents with persistent asthma, equally distributed in the supine (nocturnal) and upright positions. There was no correlation with pulmonary function test.
Assuntos
Asma/diagnóstico , Asma/epidemiologia , Ritmo Circadiano , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Adolescente , Distribuição por Idade , Brasil/epidemiologia , Criança , Comorbidade , Estudos Transversais , Monitoramento do pH Esofágico , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Manometria , Prevalência , Probabilidade , Prognóstico , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Espirometria , Estatísticas não ParamétricasRESUMO
OBJECTIVE: To assess the use of tunica vaginalis graft plus onlay preputial island flap in urethral reconstructive surgery in rabbits through histopathology. MATERIAL AND METHODS: We developed an experimental model of urethroplasty that resembles one-stage complex hypospadias surgery with divided urethral plate. The tunica vaginalis graft is dorsally placed to recreate the urethral plate and the internal preputial island flap is placed onlay to complete the urethroplasty. Sixteen animals were divided into four equal groups and sacrificed at 2, 4, 8 and 12 weeks after surgery, the penis being sent for histopathological evaluation. RESULTS: There were no deaths related to the procedure or wound breakdown; all rabbits voided spontaneously after surgery. Two urethrocutaneous fistulae were found. Microscopically, good tissue integration was observed, the tunica vaginalis mesothelium was gradually replaced by a more stratified epithelial lining, similar to the urothelial lining of the native urethra. The stratified squamous non-keratinized lining of the internal preputial island flap also changed into a thinner epithelial lining with only 4-5 cell layers. Two urethral diverticula were found. CONCLUSION: A tunica vaginalis graft placed dorsally plus an onlay internal preputial island flap was shown to be a successful technique for urethroplasty in an animal model.
Assuntos
Hipospadia/cirurgia , Membrana Serosa/transplante , Retalhos Cirúrgicos , Coleta de Tecidos e Órgãos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Animais , Inflamação/patologia , Masculino , Modelos Animais , Pênis/cirurgia , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/patologia , Coelhos , Membrana Serosa/patologia , Uretra/cirurgiaRESUMO
No presente estudo, buscou-se verificar, em pacientes cadastrados em clínica de serviço público/RJ, a adaptação das restaurações metálicas fundidas e mêtalo-cerâmicas, associando a liga metálica, o cimento e a técnica de cimentação empregados. Foram analisadas as restaurações de 60 pacientes de ambos os sexos, bem como seus prontuários. Os resultados evidenciaram que 100 por cento das restaurações foram cimentadas com cimento fosfato de zinco; 90 por cento das restaurações foram fundidas com liga de estanho/prata (Primmalloy) e 10 por cento com liga de cobre/alumínio (Duracast). Quanto à técnica de cimentação, 80 por cento das restaurações foram cimentadas com o dispositivo Medart e 20 por cento com pressão digital. Quanto às desadaptações, concluiu-se que nenhuma restauração estava com desadaptações menores que 50µ. Tinham discrepâncias 83,33 por cento das restaurações, entre 150 e 250µ, independentemente do cimento, da liga metálica e da técnica de cimentação
Assuntos
Humanos , Masculino , Feminino , Cimentação/normas , Cimentos de Ionômeros de Vidro/normas , Ligas Metalo-Cerâmicas , Microscopia Eletrônica de Transmissão e Varredura , Cimentos de ResinaRESUMO
Lower respiratory tract infections by respiratory syncytial virus (RSV) are frequent in childhood. Association of RSV with bronchiolitis obliterans has rarely been established. We report a 13-month-old child with bronchiolitis obliterans following co-infection by RSV and adenovirus, and suggest that complicated evolution of an acute bronchiolitis case can indicate an association of pathogens.
Assuntos
Bronquiolite Obliterante/complicações , Bronquiolite Obliterante/virologia , Infecções por Vírus Respiratório Sincicial/complicações , Corticosteroides/uso terapêutico , Bronquiolite Obliterante/diagnóstico , Bronquiolite Obliterante/tratamento farmacológico , Broncodilatadores/uso terapêutico , Humanos , Lactente , Masculino , Respiração Artificial , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Vírus Sinciciais Respiratórios/isolamento & purificação , Vasodilatadores/uso terapêuticoRESUMO
Lower respiratory tract infections by respiratory syncytial virus (RSV) are frequent in childhood. Association of RSV with bronchiolitis obliterans has rarely been established. We report a 13-month-old child with bronchiolitis obliterans following co-infection by RSV and adenovirus, and suggest that complicated evolution of an acute bronchiolitis case can indicate an association of pathogens.