INTRODUÇÃO: A formação médica expõe o estudante de Medicina a experiências de estresse, tornando-o potencialmente vulnerável a distúrbios emocionais. OBJETIVO: Conhecer a prevalência de sintomas depressivos entre os estudantes de Medicina da Universidade Federal de Uberlândia. MÉTODO: Os sintomas depressivos foram rastreados por meio do Inventário de Beck (IDB), aplicado a 81% dos estudantes matriculados no primeiro semestre de 2004. Os pontos de corte para ausência de sintomas depressivos, sintomas leves, moderados e graves foram, respectivamente, 0-3, 4-7, 8-15 e 16 ou mais. Levantaram-se dados demográficos por meio de questionário. RESULTADOS: Dentre os 400 acadêmicos avaliados, houve predomínio de jovens, do sexo feminino, solteiros, procedentes de Uberlândia e que moram com os pais. A prevalência de sintomas depressivos foi de 79%, sendo 29% com grau leve; 31% moderado e 19,25% grave. CONCLUSÃO: Os resultados indicam uma proporção de sintomas depressivos superior à encontrada na literatura referente a estudantes de Medicina. As excessivas cargas horárias e a ansiedade progressiva com a finalização do curso merecem maior atenção no processo de mudança curricular.

Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations.

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Background: We hypothesized that one single episode of acute kidney injury (AKI) reduces long-term survival compared with no acute kidney injury (No AKI) following recovery from critical illness. Materials and methods: A prospective cohort of 2,010 patients admitted to the ICU between 2000 and 2009 at a provincial referral hospital was followed to determine whether AKI influences long-term survival. Results: Of the 1,844 eligible patients, 18.4% had AKI stage 1, 12.1% had stage 2, 26.5% had stage 3, and 43.0% had No AKI, using the KDIGO classification. The mean and median follow-up time was 8.1 and 8.7 years. The 28-day, 1-year, 5-year and 10-year survival rates were 59.6%, 44.9%, 37.4%, and 33.4%, in patients with any AKI (stage 1, stage 2, stage 3), which was significantly worse compared with the critically ill patients with no AKI at any time (P < 0.01). The adjusted 10-year mortality risk associated with AKI was 1.44 (95% CI = 1.2 to 1.7) among 28-day survivors. Patients who had mild AKI (stage 1) had significantly worse survival at 28 days, 1 year, 3 years, 5 years and 10 years compared with No AKI (P < 0.01) ( Figure 1A). Patients with sepsis and AKI who survived 28 days had significantly poorer 5-year and 10-year survival compared with nonseptic AKI (P < 0.01) ( Figure 1B). Conclusions: Patients with one episode of mild (stage 1) AKI have significantly lower survival rates over 10 years than critically ill patients without AKI. The causes and mechanisms of this association warrant further careful study. Close medical follow-up of these patients may be warranted and mechanistic research required understanding how AKI influences distant events. P3Heparin-binding protein improves prediction of severe sepsis in the emergency departmentBackground: The early identification of risk of developing severe sepsis in patients with suspected infection remains a difficult challenge. We hypothesized that an elevated plasma level of heparin-binding protein (HBP), a neutrophil-secreted mediator of vascular leakage, would be a predictor of delayed clinical deterioration and progressive organ dysfunction in emergency department (ED) sepsis patients. Materials and methods: A prospective, multicenter study in Sweden and the US was conducted of 763 patients presenting to an ED with a suspected infection and signs of systemic inflammation. Based on recorded clinical and laboratory parameters and final diagnoses, patients were classified into various groups depending on the severity of the infection and inflammatory response. Plasma levels of HBP were measured and compared with levels of other standard sepsis biomarkers including procalcitonin, lactate, WBC, and C-reactive protein.Results: The final diagnoses were severe sepsis with organ failure in 338 patients, nonsevere sepsis without organ failure in 340 patients, and no infection in 85 patients. One-hundred and forty-three patients (19%) presented without signs of severe sepsis, but developed delayed circulatory failure and/or organ dysfunction within 72 hours of enrolment. ...

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Introduction: Malnutrition is a disease associated with unfavorable outcomes, with a high prevalence among critically ill patients. Objective: To compare the agreement between the Subjective Global Assessment (SGA) and Global Leadership Initiative on Malnutrition (GLIM) criteria in the assessment of the nutritional status of adult patients in critical condition, within the first 48 hours of admission to the ICU. In addition, the aim of the present study was to validate methods of assessing body composition to classify the nutritional status of critically ill patients, within the first 48 hours of admission to the ICU and to correlate nutritional status with the mortality of critically ill patients. Material and Methods: Prospective observational study, cohort type, with inclusion of critically ill clinical and surgical patients, ≥18 years old, mechanically ventilated.Nutritional status was assessed using the following methods: SGA; GLIM criteria; bioelectrical impedance (BIA), with analysis of the phase angle and skeletal muscle mass variables: and by ultrasound (USG), with analysis of the sectional area of the rectus femoris muscle, within the first 48 hours of admission to the ICU. Results: Article 1: Among the patients included (n=160), the prevalence of moderate and severe malnutrition demonstrated, in the first 48 hours of admission to the ICU, was 77.5% (124/160) and 14.4% (23/160) according to the SGA and GLIM criteria methods, respectively (p<0.001). Weak agreement was demonstrated between the SGA and GLIM criteria methods in the assessment of nutritional status in relation to the global diagnosis of malnutrition (κ=0.04; p=0.241) and the diagnosis of malnutrition according to subgroups (κ=0.05; p=0.073). The SGA (OR=1.39; p=0.506) and GLIM criteria (OR=1.87; 0.214) methods did not demonstrate a predictive power for mortality at 28 days. Article 2: Among the patients included (n=160), the nonsurvivors had lower values in relation to the survivors for the mean phase angle (4.4° ± 1.5 versus 4.9° ± 1.2; p=0.041) and sectional muscle area rectus femoris (6.1 ± 1.6 versus 7.4 ± 1.8; p=0.030). The cutoff values identified by means of the ROC curves were ≤4.4°, ≤19.2 kg/m 2 , and ≤5.9 cm 2 /m 2 for the phase angle; skeletal muscle mass; and sectional area of the rectus femoris muscle, respectively. In multivariate logistic regression analysis, the sectional area of A b s t r a c t the rectus femoris muscle ≤5.9 cm 2 /m 2 was the only independent predictor of 28day mortality (OR=6.08; p=0.028). In the survival analysis, greater survival at 28 days was demonstrated for patients with phase angle >4.4º (p=0.020) and sectional area of the rectus femoris muscle >5.9 cm 2 /m 2 (p=0.001).Malnourished patients had higher mortality than patients nourished according to the phase angle (31.5% versus 15.1%, respectively; p=0.015) and the area of the rectus femoris muscle (38.9% versus 6.3%, respectively; p=0.001). Conclusion:The SGA and GLIM criteria methods show low agreement in the diagnosis of malnutrition in critically ...