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BackgroundSepsis is a major public health problem, with a growing incidence and mortality rates still close to 30% in severe cases. The speed and adequacy of the treatment administered in the first hours of sepsis, particularly access to intensive care, are important to reduce mortality. This study compared the triage strategies and intensive care rationing between septic patients and patients with other indications of intensive care. This study included all patients with signs for intensive care, enrolled in the intensive care management system of a Brazilian tertiary public emergency hospital, from January 1, 2010, to December 31, 2016. The intensivist periodically evaluated the requests, prioritizing them according to a semi-quantitative scale. Demographic data, Charlson Comorbidity Index (CCI), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA), as well as surgical interventions, were used as possible confounding factors in the construction of incremental logistic regression models for prioritization and admission to intensive care outcomes.ResultsThe study analyzed 9195 ICU requests; septic patients accounted for 1076 cases (11.7%), 293 (27.2%) of which were regarded as priority 1. Priority 1 septic patients were more frequently hospitalized in the ICU than nonseptic patients (52.2% vs. 34.9%, p <  0.01). Septic patients waited longer for the vacancy, with a median delay time of 43.9 h (interquartile range 18.2–108.0), whereas nonseptic patients waited 32.5 h (interquartile range 11.5–75.8)—p <  0.01. Overall mortality was significantly higher in the septic group than in the group of patients with other indications for intensive care (72.3% vs. 39.8%, p <  0.01). This trend became more evident after the multivariate analysis, and the mortality odds ratio was almost three times higher in septic patients (2.7, 2.3–3.1).ConclusionSeptic patients had a lower priority for ICU admission and longer waiting times for an ICU vacancy than patients with other critical conditions. Overall, this implied a 2.7-fold increased risk of mortality in septic patients.

Objectives: To evaluate the association of ICU prioritization with the mortality, morbidity, and hospital length of stay in an emergency tertiary referral hospital.Sepsis persisted as an independent factor for total in-hospital mortality (2.7; 95% CI 2.32-3.17) and for the mortality of patients admitted to the ICU (2.38; 95% CI 1.82-3.11).

BackgroundOccupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed.GoalTo evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method.MethodsA group of patients in need of respiratory isolation were first identified—group I (2004; 29 patients; 44.1±3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year—group II (2007; 50 patients; 43.4±1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained.ResultsImplementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5±9.3 × 3.7±2.0; p=0.0180) and from indication to effective respiratory isolation (13.3±3.0 × 2.94±1.06; p=0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 × 75.4/100.000 patients; p<0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p<0.001 greater for 2007.ConclusionImplementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.

Tetanus remains a major health problem in developing countries. In Brazil, despite technological advances, no significant decrease in the lethality rate of tetanus have been documented in recent years. Clinical and epidemiological data from patients who were treated in Ribeirão Preto in the state of São Paulo, Brazil in the last two decades were analyzed in this case series. Retrospective data regarding the demographics, clinical presentations and prognoses of patients admitted with clinical suspicion of tetanus to a tertiary referral university hospital from 1990 to 2009 were identified. The tetanus diagnosis was defined according to the Brazilian Ministry of Health criteria. Eleven cases out of 23 patients with suspected tetanus were included in this study (47.8% of positive cases). The Tetanus Severity Score ranged from 0 to 8 points. There were no deaths, but two (18.2%) patients had permanent neurological deficits. The median length of hospital stay was 17 days (6-98 days). The absence of deaths can be explained by early clinical diagnosis and prompt treatment. Ribeirão Preto is an area in which tetanus is not a severe public health problem.

Hyporetinolemia is an independent prognostic factor in AIDS patients. Inflammatory activity causes a reduction in the serum levels of this nutrient in the general population. However, there are no studies assessing the impact of inflammatory activity on the serum retinol level in AIDS patients. A cross-sectional assessment was conducted on 41 patients hospitalized due to AIDS complications. Inflammatory markers (C-reactive protein and tumor necrosis factor-alpha) and serum retinol and retinol binding protein concentrations were quantified. Despite the low (14.6%) prevalence of hyporetinolemia, a significant negative correlation was observed between the inflammatory markers and the serum retinol and retinol binding protein levels in AIDS patients. Acute-phase inflammatory activity is associated with low serum retinol levels in individuals with AIDS.

INTRODUÇÃO: O tétano continua sendo um grave problema de saúde pública nos países em desenvolvimento. No Brasil, apesar dos avanços tecnológicos, não houve um decréscimo significativo da taxa de letalidade nos últimos anos. Nesta casuística, foram analisados dados clínicos e epidemiológicos dos pacientes diagnosticados em Ribeirão Preto, nas últimas duas décadas. MÉTODOS: Este é um estudo retrospectivo que analisou dados dos pacientes internados por tétano acidental no Hospital das Clínicas de Ribeirão Preto, entre 1990 e 2009. O diagnóstico do tétano foi realizado segundo critérios do Ministério da Saúde do Brasil. RESULTADOS: Onze (47,8%), casos positivos, dos 23 suspeitos de tétano, foram incluídos neste estudo. Não houve mortes, mas dois (18,2%) pacientes apresentaram déficit neurológico permanente. O indicador prognóstico Tetanus Severity Score variou entre 0 a 8 pontos. A mediana da permanência hospitalar foi de 17 dias, variando de 6 a 98 dias. A ausência de óbitos pode ser explicada pelo diagnóstico clinico precoce da doença com instituição imediata de terapia. CONCLUSÕES: Ribeirão Preto é uma área onde o tétano não é um relevante problema de saúde pública. INTRODUCTION: Tetanus remains a major health problem in developing countries. In Brazil, despite technological advances, no significant decrease in the lethality rate of tetanus have been documented in recent years. Clinical and epidemiological data from patients who were treated in Ribeirão Preto in the state of São Paulo, Brazil in the last two decades were analyzed in this case series. METHODS: Retrospective data regarding the demographics, clinical presentations and prognoses of patients admitted with clinical suspicion of tetanus to a tertiary referral university hospital from 1990 to 2009 were identified. The tetanus diagnosis was defined according to the Brazilian Ministry of Health criteria. RESULTS: Eleven cases out of 23 patients with suspected tetanus were included in this study (47.8% of positive cases). The Tetanus Severity Score ranged from 0 to 8 points. There were no deaths, but two (18.2%) patients had permanent neurological deficits. The median length of hospital stay was 17 days (6-98 days). The absence of deaths can be explained by early clinical diagnosis and prompt treatment. CONCLUSIONS: Ribeirão Preto is an area in which tetanus is not a severe public health problem.

Tuberculosis is one of the most important infectious disease worldwide, with 3,9 million reported cases in the world in 2002. The skeletal form is responsible for 3% of the total number of cases, with 50% of these due to spinal tuberculosis. The psoas abscess is a rare clinical entity with approximately 12 cases per year described in the medical literature and has in the Mycobacterium tuberculosis , one of its etiologic agents. The objective of this work is to report two cases of spinal tuberculosis associated with psoas abscess attended at our service, as well as a review of the literature.

Background Body packing is used for international drug transport, immediate drug concealment during a police searching or introducing drugs inside prisons. Despite the high level of specialization of dealers who have started to manufacture more complex packs, up to 5% of patients could develop intoxication due to pack rupture. Bowel obstruction is another acute complication. Case presentation A 27-year-old black male patient was sent to the hospital by court order for clinical evaluation and toxicological examination. The patient was conscious, oriented, had good color, normal arterial pressure and heart rate, and no signs of acute intoxication. Abdominal examination revealed discrete pain upon deep palpation and a small mass in the left iliac fossa. A plain abdominal radiograph revealed several oval structures located in the rectum and sigmoid. Fasting and a 50 g dose of activated charcoal every six hours were prescribed. After three days, the patient spontaneously evacuated 28 cocaine packs. Conclusion Adequate clinical management and prompt identification of potential complications are of fundamental importance in dealing with body packing.

INTRODUÇÃO: a hiporretinolemia constitui fator prognóstico independente em pacientes com AIDS, e a atividade inflamatória causa redução dos níveis séricos deste nutriente na população em geral. Entretanto, faltam estudos que avaliem o impacto da atividade inflamatória sobre o nível sérico do retinol em pacientes com AIDS. MÉTODOS: foram avaliados transversalmente 41 pacientes internados por complicações da AIDS, que tiveram quantificados alguns marcadores de inflamação (proteína C reativa e fator de necrose tumoral alfa) e concentrações séricas de retinol e da proteína de ligação do retinol. RESULTADOS: apesar da baixa (14,6%) prevalência de hiporretinolemia evidenciou-se correlação negativa dos marcadores de inflamação com os níveis séricos de retinol e de sua proteína de ligação nos pacientes com AIDS. CONCLUSÕES: a atividade inflamatória de fase aguda está associada a baixos níveis séricos de retinol em indivíduos com AIDS.INTRODUCTION: Hyporetinolemia is an independent prognostic factor in AIDS patients. Inflammatory activity causes a reduction in the serum levels of this nutrient in the general population. However, there are no studies assessing the impact of inflammatory activity on the serum retinol level in AIDS patients. METHODS: A cross-sectional assessment was conducted on 41 patients hospitalized due to AIDS complications. Inflammatory markers (C-reactive protein and tumor necrosis factor-alpha) and serum retinol and retinol binding protein concentrations were quantified. RESULTS: Despite the low (14.6%) prevalence of hyporetinolemia, a significant negative correlation was observed between the inflammatory markers and the serum retinol and retinol binding protein levels in AIDS patients. CONCLUSIONS: Acute-phase inflammatory activity is associated with low serum retinol levels in individuals with AIDS.

A tuberculose é uma das principais doenças infecciosas de acometimento mundial com 3,9 milhões de casos notificados no mundo, em 2002. A forma esquelética pode corresponder a 3% do número total de casos, sendo 50% devido à tuberculose vertebral. O abscesso de psoas é uma entidade clínica rara com aproximadamente 12 casos relatados por ano na literatura médica e tem no Mycobacterium tuberculosis, um dos seus agentes etiológicos. O objetivo deste trabalho é relatar dois casos de tuberculose vertebral associada a abscesso de psoas atendidos em nosso serviço, bem como uma revisão da literatura.Tuberculosis is one of the most important infectious disease worldwide, with 3,9 million reported cases in the world in 2002. The skeletal form is responsible for 3% of the total number of cases, with 50% of these due to spinal tuberculosis. The psoas abscess is a rare clinical entity with approximately 12 cases per year described in the medical literature and has in the Mycobacterium tuberculosis , one of its etiologic agents. The objective of this work is to report two cases of spinal tuberculosis associated with psoas abscess attended at our service, as well as a review of the literature.