Einstein (São Paulo, Brazil)
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Einstein (Sao Paulo) · Jul 2016
Associated factors with mammographic changes in women undergoing breast cancer screening.
To evaluate association of sociodemographic, anthropometric, and epidemiological factors with result of mammogram in women undergoing breast cancer screening. ⋯ Mulheres hipertensas submetidas à mamografia de rastreamento tiveram maiores chances de apresentarem alterações mamográficas, ao passo que mulheres praticantes de atividade física apresentaram uma chance menor (70%) de terem alteração na mama em relação às sedentárias.
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Einstein (Sao Paulo) · Jul 2015
Comparative StudyComparative analysis of survival between elderly and non-elderly severe sepsis and septic shock resuscitated patients.
To compare outcomes between elderly (≥65 years old) and non-elderly (<65 years old) resuscitated severe sepsis and septic shock patients and determine predictors of death among elderly patients. ⋯ In this study population early resuscitation of elderly patients was not associated with increased in-hospital mortality. Prospective studies addressing the long-term impact on functional status and quality of life are necessary.
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Einstein (Sao Paulo) · Jul 2015
ReviewHow to choose the therapeutic goals to improve tissue perfusion in septic shock.
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. ⋯ The adjustments necessary for adequate tissue blood flow and therefore of oxygen supply to metabolic demand according to the assessment of the cardiac index and oxygen extraction rate should be performed during resuscitation period, especially in high complexity patients. New technologies, easily handled at the bedside, and new studies that directly assess the impact of macro-hemodynamic parameter optimization on microcirculation and in the clinical outcome of septic patients, are needed.
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Einstein (Sao Paulo) · Jul 2015
ReviewFluid therapy for septic shock resuscitation: which fluid should be used?
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. ⋯ Additionally, when large amounts of fluids are necessary to restore the hemodynamic stability, albumin solutions may be a safe and effective alternative. Hydroxyethyl starches solutions must be avoided in septic patients due to the increased risk of acute renal failure, increased need for renal replacement therapy and increased mortality. Our objective was to present a narrative review of the literature regarding the major types of fluids and their main drawbacks in the initial resuscitation of the septic shock patients.