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Describir los predictores de mortalidad en pacientes hospitalizados con síndrome respiratorio agudo severo (SARS) debido a COVID-19 que presentan hipoxemia silente.

Comorbidities are common in COPD and have been associated with reduced health status, increased health care utilization, all-cause hospitalization, and mortality. There is a scarcity of data on the relationship between comorbidities and functional capacity.

AbstractBackground: Although acute renal failure (ARF) is a frequent complication of severe leptospirosis, there are few studies on renal function recovery in the literature. The objective of the present study was to verify how and when renal function recovery occurs after leptospirosis ARF. Patients and Methods: 35 patients with leptospirosis ARF (plasma creatinine [Pcreat] ≥133 μmol/l at hospital admission) were prospectively studied during hospitalization, at discharge and 3 and 6 months after discharge. Creatinine clearance, fractional excretion of sodium and potassium, proteinuria and sodium proximal reabsorption were measured under normal sodium diet. Urinary pH and the ratio urinary to plasma osmolality (U/Posm) were measured 18 h after food and water withdrawal. All parameters were also measured in 18 healthy volunteers. Presence of laboratorial alterations usually found in leptospirosis were evaluated in the patients. Patients were divided in 2 groups according to their maximum Pcreat value during hospitalization: group 1 ( Pcreat >442 μmol/l, n = 21), and group 2 (Pcreat ≤442 μmol/l, n = 14). Results: All patients presented with jaundice, fever and myalgia. Bilirubin and creatine kinase were higher in group 1. Oliguria was observed in 11% of all patients and 49% required dialysis; all these patients were from group 1. All renal parameters were normal at the 6th month except U/Posm that remained lower than normal. The pattern of renal function recovery was similar in both groups except for urinary volume. Conclusion: After leptospirosis ARF, renal function recovery is fast and complete after 6 months, except for urinary concentration capacity.Copyright © 2004 S. Karger AG, Basel

Chagas' disease is an endemic clinical entity caused byTrypanosoma cruzi,a parasite that is transmitted to humans by the hematophagic Triatominae insects. It affects several million persons in Latin America, mostly in Brazil, Argentina, Chile, Paraguay, and Bolivia. Megacolon, the most common complication of intestinal trypanosomiasis, results in severe constipation, for which surgery is indicated. A variety of procedures have been proposed for the correction of this disabling condition including sigmoidectomy, abdominal rectosigmoidectomy, left colectomy, and subtotal colectomy. On long-term follow-up, however, these operations have proved to be inadequate in a significant number of cases, apparently due to preservation of the dyskinetic rectum which continues to act as a functional obstacle to the progression of the fecal bolus. On the other hand, pull-through operations, which include the removal of all or almost all of the dyskinetic rectum, or the exclusion of the rectum, as in the Duhamel-Haddad operation, have been demonstrated to be superior.

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The present study was performed to identify tumor cells in lymph nodes from colorectal adenocarcinomas considered free of disease by the classic hematoxylin-eosin stain, based on the detection of the carcinoembryonic antigen (CEA) and cytokeratins in neoplastic epithelial cells. For this purpose, 603 lymph nodes from 46 lesions were stained by the peroxidase-antiperoxidase technique. Tumor cells were detected in 22 nodes from 12 patients, mainly in the subcapsular sinuses, permitting a restaging of these patients into two groups: those now considered to have metastatic disease and those free of metastases. However, the 5-year follow-up showed no statistical differences in survival between the two groups.

Chagas' disease is an endemic clinical entity caused byTrypanosoma cruzi,a parasite that is transmitted to humans by the hematophagic Triatominae insects. It affects several million persons in Latin America, mostly in Brazil, Argentina, Chile, Paraguay, and Bolivia. Megacolon, the most common complication of intestinal trypanosomiasis, results in severe constipation, for which surgery is indicated. A variety of procedures have been proposed for the correction of this disabling condition including sigmoidectomy, abdominal rectosigmoidectomy, left colectomy, and subtotal colectomy. On long-term follow-up, however, these operations have proved to be inadequate in a significant number of cases, apparently due to preservation of the dyskinetic rectum which continues to act as a functional obstacle to the progression of the fecal bolus. On the other hand, pull-through operations, which include the removal of all or almost all of the dyskinetic rectum, or the exclusion of the rectum, as in the Duhamel-Haddad operation, have been demonstrated to be superior. The abdominoperineal endoanal pull-through resection with delayed colorectal anastomosis and the Duhamel-Haddad operation are the most accepted procedures in Brazil and other Latin American countries; their technical details are illustrated. Functional results are satisfactory. Anal continence is normal in the vast majority of cases and sexual disturbances are rare. Routine treatment of 2 main complications—fecaloma and volvulus of the sigmoid colon—are discussed. La maladie de Chagas est une entité clinique endémique provoquée par le Trypanosome cruzi, parasite transmis aux hommes par les insectes Triatominae hématophagi. Elle affecte plusieurs millions d'individus en Amérique Latine, surtout au Brésil, en Argentine, au Chile, au Paraguay, et au Bolivie. Le mégacôlon, complication la plus courante de la trypanosomiase intestinale se traduit par une constipation grave pour laquelle la chirurgie est indiquée. Différents procédés ont été proposés pour corriger cet état invalidant comprenant sigmoïdectomie, rectosigmoïdectomie, colectomie gauche, et colectomie subtotale. Un bon nombre de ces interventions se sont avérées inadaptées dans les suites à long terme ce qui est apparemment dû à la conservation du rectum dyskinétique qui continue à agir comme obstacle fonctionnel à la progression des selles. Par ailleurs, les interventions par retournement qui comprennent l'ablation soit totale soit subtotale du rectum dyskinétique ou son exclusion comme dans l'intervention de Duhamel-Haddad, se sont avérées meilleures. La résection abdominopérinéale par retournement avec anastomose colorectale retardée et l'intervention de Duhamel-Haddad sont les processus les plus couramment employés au Brésil et dans les autres pays d'Amérique Latine; les détails techniques sont illustrés. Les résultats fonctionnels sont satisfaisants. La continence est normale dans la plus grande majorité des cas et les troubles sexuels sont rares. Le traitement systématique des 2 complications principales, fécalome et volvulus du côlon sigmoïde, sont discutées. La enfermedad de Chagas es una entidad clínica de carácter endémico transmitida al ser humano por insectos triatomídeos. Afecta a varios millones de personas en América Latina, principalmente en Brasil, Argentina, Chile, Paraguay, y Bolivia. El megacolon es una de las complicaciones más comunes de esta enfermedad. La cirugia esta indicada en la gran mayoría de los casos y tiene como propósito principal curar el severo estreñimiento que afecta a la mayoría de los pacientes. Entre los procedimientos quirúrgicos que han sido propuestos, la sigmoidectomía, la rectosigmoidectomía abdominal, la colectomía izquierda, y la colectomía total han demostrado ser ineficaces, en un número significativo de casos, en el seguimiento a largo plazo, ciertamente porque en estos procedimientos se preserva el recto disquinético, el cual continúa actuando como un obstáculo funcional al avance del bolo fecal. Por el contrario, las operaciones de tipo “pull-through” han demostrado mayor efectividad, en virtud de que incluyen la resección de la totalidad o de la casi totalidad del recto disquinético, o su exclusión, como en la operación de Duhamel-Haddad. La resección abdominoperineal con “pull-through” endoanal y la operación de Duhamel-Haddad son los 2 procedimientos de preferencia en Brasil y en las naciones latinoamericanas. Se ilustran sus detalles técnicos. La continencia anal queda normal en la mayoría de los casos operados y la disfunción sexual es rara. Se discute el tratamiento rutinario de otras 2 complicaciones—el fecaloma y el vólvulos del sigmoide.

Initiated spores and vegetative cells of the gramicidin S-producing Bacillus brevis Nagano were compared with respect to their resistance to various forms of stress (osmotic shock-starvation, exposure to ethanol, sonic oscillation, and heat). The resistance of initiated spores to all of these stress situations was considerably greater than that of vegetative cells and approached that of dormant spores. The period during which the initiated spores remained resistant to heat was extended by addition of gramicidin S. The antibiotic may therefore be of survival value to the species in nature by slowing down the development of initiated spores in the outgrowth phase of germination, thereby extending the period during which the cells are resistant to environmental stress.

The authors review their experience with stapled anastomosis in colorectal and ileorectal resections for malignant and benign lesions of the large bowel. They describe the technique and results in a series of 49 patients (24 with cancer of the rectum and rectosigmoid junction; six with familial polyposis, associated with cancer in four; 12 with chagastic megacolon; three, Crohn’s disease; two, ulcerative colitis; and one each, diverticular sigmoiditis and ischemic sigmoiditis). Anterior resection was performed in 38 patients and total colectomy with ileorectal anastomosis in 11. Main complications and mortality are presented. They conclude that stapled anastomosis is an efficient method for intestinal reconstruction after resection for malignant and benign lesions of the large bowel

Certain Bacillus brevis strains produce gramicidin S (GS) during sporulation, and germination of such spores is delayed at the stage of outgrowth by endogenous or exogenous GS. Claims have been made that the transition from germinating spores into vegetative cells is dependent on GS destruction. We observed no such destruction of either exogenous or endogenous GS. Thus, in our hands, the “recovery” of the inhibited germinating spores must be dependent on something other than GS elimination.