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Objectives During the COVID-19 pandemic, several cases of changes in olfaction and taste associated with the infection have been reported. Therefore, otolaryngologists are frequently the first medical professionals sought by patients. The aim of this study was to evaluate the frequency of olfaction and taste disorders in patients hospitalized with COVID-19, and their association with other clinical manifestations and patient evolution during hospitalization. Methods 248 patients, admitted to three public hospitals in Belo Horizonte, Minas Gerais, Brazil, were prospectively included: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), Hospital Júlia Kubitschek (HJK) and Hospital Eduardo de Menezes (HEM), who, upon admission to hospital, presented with Severe Acute Respiratory Syndrome due to COVID-19. Clinical and laboratory variables and outcomes during hospitalization were prospectively collected from the electronic medical records. The collection of sociodemographic and symptomatology data during the acute phase was carried out prospectively in electronic medical records and confirmed with the patients at a subsequent outpatient visit. Results The most frequently reported symptoms were dyspnea (77.4%), cough (69.8%) and fever (55.2%). During the acute phase of the disease, 95 (38.3%) and 87 (35.1%) patients reported taste and olfaction disorders, respectively. There was a lower prevalence of dysosmia among patients with previous comorbidities (p

Qualitative and quantitative alterations in ileal flora during obstructive jaundice and the role of bile salts were evaluated in rats. Obstructive jaundice was associated with bacterial overgrowth in the ileum. This effect may be due to the reduced concentration of bile salts, since dietary supplementation reduced the small bowel aerobic bacterial flora.As alterações qualitativas e quantitativas da flora ileal na obstrução biliar e o papel dos sais biliares foram avaliados em ratos. Em animais com obstrução biliar houve aumento da população ileal. Esse efeito é provavelmente causado pela ausência de sais biliares no lúmen ileal, uma vez que em animais cuja dieta foi suplementada com sais biliares houve redução da flora ileal.

O choque septico acomete 9% dos pacientes admitidos em unidades de tratamento intensivo (UTIs), com mortalidade acima de 50%. O inicio rapido do tratamento e essencial, com emprego imediato de antibioticos eficazes, eliminacao de sitio de infeccao, se possivel, e tratamento de suporte. O tratamento de suporte se baseia na expansao volemica e no uso de vasopressores. Outras medidas como ventilacao artificial, nutricao, suporte inotropico, controle glicemico, correcoes de disturbios eletroliticos e acidobasicos sao tambem relevantes. A noradrenalina, empregada frequentemente em doses acima das usuais, tem sido o vasopressor de escolha. Esse estudo objetivou avaliar a morbidade e a mortalidade de pacientes com choque septico que usaram noradrenalina, e o papel de outras variaveis intervenientes nodesfecho. Incluiram-se 289 pacientes com choque septico e que receberam noradrenalina. Os casos foram selecionados nas UTIs de sete hospitais de Minas Gerais no periodo de 01 de maio de 2004 a 31 de dezembro de 2005. Os pacientes foram acompanhados diariamente ate o momento da alta hospitalar ou obito. Em 93,4% (270/289) dos pacientes foi possivel identificar o sitio de infeccao: pulmonar (54,3%), abdominal (24,6%), urinario (6,6%), pele e partes moles (3,1%) e outros (4,8%). A mediana do indice de APACHE II situou-se em 16. Entre 289 pacientes, a mortalidade na UTI foi de 68,9%. Todos os 65 pacientes que usaram pico de dose de noradrenalina acima de 2,37 mg/kg/minfaleceram na UTI. O uso de doses mais elevadas de noradrenalina teve relacao com maior mortalidade na UTI, maior monitorizacao de pressao intra-arterial e com cateter de arteria pulmonar, maior emprego de ventilacao artificial, dobutamina, midazolam, maior indice de APACHE II, mais tempo de uso e maior dose de dobutamina, menor tempo de monitorizacao da pressao venosa central e de uso de ventilacao artificial. Houve diferenca de mortalidade na UTI em razao do pico de dose de noradrenalina utilizada. Entre os pacientes que sobreviveram a terapia intensiva, a maior dose empregada foi de 2,37 mg/kg/min. Entre ospacientes que nao sobreviveram, chegou a ser empregado 14,5 mg/kg/min. Os pacientes nao sobreviventes tambem apresentaram indice de APACHE II mais elevado, maior emprego de hemodialise, monitorizacao de pressao intra-arterial e ventilacao artificial, receberam dose maior de dobutamina e desenvolveram insuficiencia renal aguda mais frequentemente. Nesse estudo, idade, sexo, clinica de origem, hospital participante, emprego de corticoide, dopamina, dobutamina, fentanil e midazolam, numero de doencas associadas, sitio de infeccao, dose de dopamina, tempo de uso de noradrenalina e emprego demonitorizacao hemodinamica nao estiveram associados a mortalidade na UTI em pacientes com choque septico. O indice de APACHE II, a dose de noradrenalina e o desenvolvimento de insuficiencia renal aguda se mostraram marcadores independentes de mortalidade na UTI. A dose de noradrenalina, quando acima de 0,785 Êg/kg/min, sinalizou prognostico desfavoravel, enquanto ao ultrapassar 2,37 Êg/kg/min nao trouxe beneficios, com mortalidade na UTI de 100%. Among patients admitted into intensive care units (ICU), 9% present septic shock. More than 50% of them die. The implementation of rapid treatment is essential, with immediate usage of antibiotics, infectious focus elimination, if applicable, and supportive treatment. First, the supportive treatment is based in fluid resuscitation and the use of vasopressors. Other measures such as artificial ventilation, nutrition, inotropic support, glucose control, corrections of electrolytic and acid-basic imbalance are also essential for the patients recovery.Norepinephrine has been the vasopressor of choice, used frequently above usual doses. The aim of this study was to evaluate the morbidity and mortality of patients with septic shock who used norepinephrine. The importance of other intervening variables in the outcome of septic shock patients was also analyzed. We enclosed 289 septic shock patients admitted in the ICUs of seven hospitals of Minas Gerais between May 1st, 2004 and December 31st, 2005 who used norepinephrine. The patients were followed everyday until the patients discharge. It was possible to identify the site of infection in 93.4% (270/289) of studied patients: lung (54.3%), abdomen (24.6%), urinary tract (6.6%), skin and soft tissue (3.1%) and others (4.8%). In 6.6% of patients it was not possible toidentify the site of infection. The median of the index of APACHE II was 16.Among the 289 patients, the ICU mortality was 68.9%. All the 65 patients who used norepinephrine above 2.37 mg/kg/min died before being discharged from ICU. When the patients were compared, the group which used higher doses of norepinephrine used pulmonary artery catheter and intra-arterial catheter more often, received more frequently artificial ventilation, dobutamine and midazolam, had a higher APACHE II index, used higher dose and more time of dobutamine, with lower time of use of central venous pressure monitoring and artificial ventilation. When the different cut-off points of maximum dose of norepinephrine are compared, a statistical difference in ICU mortality was also observed. Themaximum dose of norepinephrine among patients who survived in the ICU was 2.37 mg/kg/min. Among the nonsurvivors, norepinephrine was used until the dose of 14.5 mg/kg/min. Also, the nonsurvivors had a higher APACHE II index, were submitted to hemodialysis, intra-arterial catheter monitoring and artificial ventilation more often, received a higher dose of dobutamine and developed more often acute renal failure. This study showed that age, sex, hospital, site of infection, use of corticoids, dopamine, dobutamine, fentanyl, midazolam, number of co-morbidities, dose of dopamine, duration of norepinephrine use and implement of haemodynamic monitoring were not associated with ICU mortality inseptic shock patients. The APACHE II index, the dose of norepinephrine and the development of an acute renal failure were independently associated to a higher ICU mortality rate. In this sample, the norepinephrine dose was a marker for ICU mortality. Norepinephrine dose above 0,785 mg/kg/min pointed to bad outcome and above 2.37 mg/kg/min did not show benefit because the ICU mortality in this last group was 100%.

A procura pelos serviços de emergência tem sido crescente nas últimas décadas. As doenças respiratórias estão entre as principais causas que levam à procura do sistema de urgência e emergência no Brasil. O PS (Pronto Socorro) necessita de recursos tecnológicos propedêuticos e/ou terapêuticos mínimos para o atendimento de pacientes de alta complexidade. A UPA (Unidade de Pronto Atendimento), com complexidade intermediária situada entre Atenção Básica de Saúde e Atenção Hospitalar, tem sido a porta de entrada para pacientes de alta complexidade que necessitam de uma estrutura hospitalar adequada para este atendimento. É comum pacientes permanecerem horas aguardando transferência para Unidades de Tratamento Intensivo (UTIs), mesmo apresentando quadros clínicos complexos. Objetivo: O objetivo deste trabalho foi avaliar o desfecho de pacientes com IRpA (Insuficiência Respiratória Aguda) admitidos em Pronto Socorro e em Unidade de Pronto Atendimento. Também foi avaliado o tempo até a transferência para a UTI. Foram verificadas as associações entre local de atendimento inicial e tempo de internação na UTI, tempo de ventilação artificial e mortalidade. Método: Foram acompanhados sequencialmente 488 pacientes admitidos com IRpA em PS e em UPA, com idade maior ou igual a 18 anos. A coleta de dados foi realizada através da análise de prontuários com inserção das informações em ficha padrão com as variáveis necessárias ao estudo. Foram analisados APACHE II e SAPS 3 como escores de gravidade dos pacientes. Resultados: Observou-se elevado tempo de espera para transferência para UTI entre os pacientes sobreviventes (mediana = 31,67 horas). A mortalidade na sala de emergência foi maior na UPA (25,6%) em relação ao PS (15,3%). Os pacientes admitidos na UPA eram mais graves que os admitidos no PS. Após análise multivariada, o local de atendimento inicial não se associou de forma independente com o óbito. A maior mortalidade na UPA em relação ao PS foi explicada pela diferença de gravidade dos pacientes. Após análise multivariada, observou-se que o local de atendimento inicial esteve associado de forma independente com a mortalidade na UTI. Conclusão: Observou-se desfechos diferentes conforme o local de atendimento inicial em pacientes com IRpA, o que permite identificar oportunidades de otimização na assistência em saúde dos indivíduos admitidos em serviços de emergência. Propõe-se a criação de estratégias e protocolos nas instituições e na regulação médica que seguramente trarão impacto na segurança e na qualidade da assistência prestada. The demand for emergency services has been growing in recent decades. Respiratory diseases are among the main causes that lead to the demand for the urgency and emergency system in Brazil. The ER (Emergency Room) needs minimal propaedeutic and / or therapeutic technological resources for the care of highly complex patients. The ECU (Emergency Care Unit), with an intermediate complexity located between Basic Health Care and Hospital Care, has been the gateway for highly complex patients who need an adequate hospital structure for this care. It is common for patients to spend hours waiting for transfer to Intensive Care Units (ICUs), even with complex clinical conditions. Objective: The aim of this study was to evaluate the outcome of patients with ARF (Acute Respiratory Insufficiency) admitted to the Emergency Room and the Emergency Care Unit. The time until transfer to the ICU was also assessed. Associations between place of initial care and length of stay in the ICU, time on artificial ventilation and mortality were verified. Method: 488 patients admitted with IRPA in ER and in ECU, aged 18 years or older, were followed up sequentially. Data collection was performed through the analysis of medical records with insertion of information in a standard form with the variables necessary for the study. APACHE II and SAPS 3 were analyzed as severity scores for patients. Results: There was a long waiting time for transfer to the ICU among surviving patients (median = 31.67 hours). Mortality in the emergency room was higher in the ECU (25.6%) compared to the ER (15.3%). Patients admitted to the ECU were more severe than those admitted to the ER. After multivariate analysis, the place of initial care was not independently associated with death. The higher mortality in the ECU in relation to the ER was explained by the difference in severity of the patients. After multivariate analysis, it was observed that the initial care location was independently associated with ICU mortality. Conclusion: Different outcomes were observed according to the place of initial care in patients with ARF, which allows identifying opportunities for optimization in health care for individuals admitted to emergency services. It is proposed to create strategies and protocols in institutions and in medical regulation that will surely have an impact on the safety and quality of care provided.