In an HF outpatient clinic, B-lines were significantly correlated with more established parameters of decompensation. A B-line ≥15 cutoff could be considered for a quick and reliable assessment of decompensation in outpatients with HF.
Introduction. Spontaneous bacterial peritonitis (SBP) has a deleterious clinical impact in end-stage liver disease, and multidrug resistance has increased, raising concern about effectiveness of traditional antibiotic regimens. Patients and Methods. Single-center retrospective study of ascitic fluid infections in cirrhotic patients. Results. We analyzed medical records related to 2129 culture-positive ascitic fluid and found 183 samples from cirrhotic patients. There were 113 monobacterial SBP cases from 97 cirrhotic patients; 57% of patients were male; hepatitis C and alcohol were the main etiologies for cirrhosis. Multidrug resistant bacteria were isolated in 46.9% of SBP samples, and third-generation cephalosporin and quinolone resistant reached 38.9% and 25.7% of SBP cases. Conclusion. SBP due to multidrug resistant bacteria is a growing problem, and one should consider reported resistance profiles for the decision-making process of empirical first-line treatment prescription.
BackgroundRisk stratification of a syncopal episode is necessary to better differentiate
patients needing hospitalization of those who can be safely sent home from the
emergency department. Currently there are no strict guidelines from our Brazilian
medical societies to guide the cardiologist that evaluate patients in an emergency
setting.ObjectivesTo analyze the criteria adopted for defining the need for hospitalization and
compare them with the predictors of high risk for adverse outcome defined by the
OESIL score that is already validated in the medical literature for assessing
syncope.MethodsA cross-sectional study of patients diagnosed with syncope during emergency
department evaluation at our institution in the year 2011.ResultsOf the 46,476 emergency visits made in that year, 216 were due to syncope. Of the
216 patients analyzed, 39% were hospitalized. The variables associated with the
need of hospital admission were - having health care insurance, previous known
cardiovascular disease, no history of prior stroke, previous syncope and abnormal
electrocardiograms during the presentation. Patients classified in OESIL scores of
0-1 had a greater chance of emergency discharge; 2-3 scores showed greater
association with the need of hospitalization. A score ≥ 2 OESIL provided an odds
ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95%
CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found
and in 18% cardiac cause was identified.ConclusionsFactors such as cardiovascular disease, prior history of syncope, health
insurance, no previous stroke and abnormal electrocardiograms, were the criteria
used by doctors to indicate hospital admission. There was a good correlation
between the clinical judgment and the OESIL criteria for high risk described in
literature.
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