The mortality rate of chronic obstructive pulmonary disease (COPD) patients with community-acquired pneumonia (CAP) is reported to be low. However, studies carried out to date have included ,20% of critically ill patients.The current authors performed a secondary analysis of a prospective study evaluating 428 immunocompetent patients admitted to the intensive care unit (ICU) for severe CAP.In total, 176 COPD patients were compared with 252 non-COPD patients. In COPD patients, ICU mortality (odds ratio (OR) 1.58; 95% confidence interval (CI) 1.01-1.43) and mechanical ventilation (OR 2.78; 95% CI 1.63-4.74) rates were higher than in non-COPD patients. The ICU mortality was 39% for COPD patients initially intubated and 50% for those who failed noninvasive ventilation. The proportion of patients who were males, aged o70 yrs, smokers and who had chronic heart disease or Pseudomonas aeruginosa were higher in COPD patients. Inappropriate empirical antibiotic therapy was associated with higher mortality (OR 3.8; 95% CI 1.19-12.6). ICU mortality in COPD patients with adequate therapy was associated with bilateral pneumonia (OR 2.32; 95% CI 1.18-4.53) and shock (OR 3.53; 95% CI 1.31-9.71).In conclusion, chronic obstructive pulmonary disease patients hospitalised with communityacquired pneumonia in the intensive care unit had higher mortality and need of mechanical ventilation when compared with patients without chronic obstructive pulmonary disease.
These data suggest that a more aggressive treatment strategy, with earlier and easier access to the antiviral treatment might reduce the number of ICU admissions and mortality.
We report a case of atraumatic spontaneous posterior subluxation of the sternoclavicular joint in a 19-year-old woman without any known underlying pathology. There was no history of injury. The patient was treated operatively using the gracilis tendon to reinforce the anterior sternoclavicular ligament. One year later the patient is asymptomatic and has returned to her usual life.
Los autores agradecen a los jóvenes y padres la predisposición mostrada para el desarrollo de este estudio. También, la incondicional colaboración del club Fútbol Femenino Salamanca, materializada en la ayuda de los técnicos y responsables de las categorías inferiores. Código UNESCO: 5899 Educación Física y Deportiva / Physical education and sport. Clasificación del Consejo de Europa: 17. Otras (iniciación deportiva) / Other (sport initiation).
La eficiencia en el uso de la radiación (EUR) de un cultivo es la relación entre la materia seca producida y la radiación fotosintéticamente activa interceptada(RFAI) durante su ciclo. La fracción de radiación fotosintéticamente activa interceptada (fRFAI) puede determinarse mediante el método tradicional de Beer, a partir del índice de área foliar (iaf), o empleando la cobertura del suelo (f), como medida subrogante de fRFAI. Cuando el iaf en papa supera 3, el valor de fRFAI cambia muy poco, haciendo muy difícil detectar diferencias debidas a variaciones en las condiciones del cultivo. El objetivo de este trabajo fue determinar la EUR en papa (Solanum tuberosum L.) cv. Spunta, comparando el uso de valores de iaf y de f para obtener fRFAI. El ensayo se realizó en el cinturón verde de Córdoba, Argentina, sobre un cultivo de ciclo tardío entre febrero y mayo de 2008. La utilización del valor de f produjo resultados que sobre estiman EUR,como consecuencia de una sistemática subestimación de fRFAI, mientras que tomando valores de fRFAI corregidos de acuerdo a la relación con f previamente establecida, EUR resultó similar a la obtenida con el método de referencia, que presentó un valor de 2,90 gr MJ-1 PAR.
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