Volume 13, Number 3, July/September 2015

How to choose the therapeutic goals to improve tissue perfusion in septic shock

Murillo Santucci Cesar de Assuncao, Thiago Domingos Corrêa, Bruno de Arruda Bravim, Eliézer Silva

DOI: 10.1590/S1679-45082015RW3148

The early recognition and treatment of severe sepsis and septic shock is the key to a successful outcome. The longer the delay in starting treatment, the worse the prognosis due to persistent tissue hypoperfusion and consequent development and worsening of organ dysfunction. One of the main mechanisms responsible for the development of cellular dysfunction is tissue hypoxia. The adjustments necessary for adequate tissue blood flow and therefore of oxygen supply to metabolic demand according to the assessment of the cardiac […]

Strategies for appropriate antibiotic use in intensive care unit

Camila Delfino Ribeiro da Silva, Moacyr Silva Júnior

DOI: 10.1590/S1679-45082015RW3145

The comsumption of antibiotics is high, mainly in intensive care units. Unfortunately, most are inappropriately used leading to increased multi-resistant bacteria. It is well known that initial empirical therapy with broad-spectrum antibiotics reduce mortality rates. However the prolonged and irrational use of antimicrobials may also increase the risk of toxicity, drug interactions and diarrhea due to Clostridium difficile. Some strategies to rational use of antimicrobial agents include avoiding colonization treatment, de-escalation, monitoring serum levels of the agents, appropriate duration of […]

Acute management of unstable angina and non-ST segment elevation myocardial infarction

Fernando Morita Fernandes Silva, Antonio Eduardo Pereira Pesaro, Marcelo Franken, Mauricio Wajngarten

DOI: 10.1590/S1679-45082015RW3172

Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high.

Fluid therapy for septic shock resuscitation: which fluid should be used?

Thiago Domingos Corrêa, Leonardo Lima Rocha, Camila Menezes Souza Pessoa, Eliézer Silva, Murillo Santucci Cesar de Assuncao

DOI: 10.1590/S1679-45082015RW3273

Early resuscitation of septic shock patients reduces the sepsis-related morbidity and mortality. The main goals of septic shock resuscitation include volemic expansion, maintenance of adequate tissue perfusion and oxygen delivery, guided by central venous pressure, mean arterial pressure, mixed or central venous oxygen saturation and arterial lactate levels. An aggressive fluid resuscitation, possibly in association with vasopressors, inotropes and red blood cell concentrate transfusion may be necessary to achieve those hemodynamic goals. Nonetheless, even though fluid administration is one of […]

Higher overall survival in metastatic pancreatic cancer: the impact of where and how treatment is delivered

Pedro Luiz Serrano Usón Junior, Monique Sedlmaier França, Heloisa Veasey Rodrigues, Antônio Luiz de Vasconcellos Macedo, Alberto Goldenberg, Oren Smaletz, [...]

DOI: 10.1590/S1679-45082015AO3303

ObjectiveTo determine the overall survival of patients with advanced pancreatic cancer and evaluate factors that impact prognosis in a private cancer center.MethodsData from the Hospital Cancer Registry at Hospital Israelita Albert Einstein were retrospectively collected. The patients enrolled had metastatic cancer at diagnosis or earlier staging and subsequent recurrence. Cases of neuroendocrine tumors were excluded.ResultsA total of 65 patients were evaluated, including 63 with adenocarcinoma. The median overall survival for patients in all stages was 20.7 months (95%CI: 15.6-25.7), while […]

Chronic psychological stress and its impact on the development of aggressive breast cancer

Thayse Fachin Cormanique, Lirane Elize Defante Ferreto de Almeida, Cynthia Alba Rech, Daniel Rech, Ana Cristina da Silva do Amaral Herrera, Carolina Panis

DOI: 10.1590/S1679-45082015AO3344

ObjectiveTo investigate the clinicopathological findings of women diagnosed with breast cancer and study the impact of chronic psychological stress on the pathological characteristics of these tumors.MethodsWe investigated a cohort composed of women diagnosed with breast cancer and divided into two groups. One group was categorized as presenting with chronic psychological stress (by using the Self-Reporting Questionnaire − SRQ-20). Another group of women with breast cancer, but with no previous history of chronic psychological stress, comprised the Control Group. Clinical and […]

Body surface infrared thermometry in patients with central venous cateter-related infections

José Henrique Silvah, Cristiane Maria Mártires de Lima, Maria do Rosário Del Lama de Unamuno, Marco Antônio Alves Schetino, Luana Pereira Leite Schetino, Priscila Giácomo Fassini, [...]

DOI: 10.1590/S1679-45082015AO3397

ObjectiveTo evaluate if body surface temperature close to the central venous catheter insertion area is different when patients develop catheter-related bloodstream infections.MethodsObservational cross-sectional study. Using a non-contact infrared thermometer, 3 consecutive measurements of body surface temperature were collected from 39 patients with central venous catheter on the following sites: nearby the catheter insertion area or totally implantable catheter reservoir, the equivalent contralateral region (without catheter), and forehead of the same subject.ResultsA total of 323 observations were collected. Respectively, both in […]

Clinical characteristics and long-term progression of young patients with acute coronary syndrome in Brazil

Alexandre de Matos Soeiro, Felipe Lourenço Fernandes, Maria Carolina Feres de Almeida Soeiro, Carlos Vicente Serrano Jr, Múcio Tavares de Oliveira Jr

DOI: 10.1590/S1679-45082015AO3381

ObjectiveIn Brazil, there are few descriptions in the literature on the angiographic pattern and clinical characteristics of young patients with acute coronary syndrome, despite the evident number of cases in the population. The objective of this study was to evaluate which clinical characteristics are most closely related to the acute coronary syndrome in young patients, and what long-term outcomes are in this population.MethodsThis is a prospective observational study with 268 patients aged under 55 years with acute coronary syndrome, carried […]

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