Resumo Objetivo analisar os fatores associados à readmissão de atendimento ao Serviço de Atendimento Móvel de Urgência (SAMU). Método estudo epidemiológico, do tipo seccional. Analisaram-se dados de ...600 pacientes adultos atendidos pelo serviço de um município do interior de São Paulo, Brasil, no ano de 2015. Uma regressão logística múltipla identificou os fatores associados à readmissão. Resultados predominaram o atendimento de ocorrências clínicas, pacientes do sexo masculino e média de idade de 55,5 anos. Identificou-se um retorno de 26,7% nos seis meses seguintes ao atendimento no serviço pré-hospitalar. As readmissões se associaram aos fatores clínicos dos pacientes, aos procedimentos realizados no ambiente pré-hospitalar móvel e ao fluxo intra-hospitalar. Ademais, foi possível verificar relação com a região da cidade na qual o estudo foi realizado. Conclusão e implicações para a prática a análise mostrou um perfil de atendimentos a pacientes com idade média de 55 anos e acometidos por doenças crônicas não transmissíveis. A chance de retorno se associou à natureza clínica da doença, aos fluxos assistenciais e à região do atendimento. Estudos como este auxiliam no planejamento e na elaboração de políticas públicas e ações em saúde condizentes com as necessidades identificadas, com potencial de auxiliar na diminuição da sobrecarga dos serviços de urgência.
Resumen Objetivo analizar los factores asociados al retorno al Servicio de atención móvil de urgencias. Método estudio epidemiológico transversal. Se analizaron datos de 600 pacientes adultos atendidos por el servicio en una ciudad del interior de São Paulo, Brasil, en 2015. La regresión logística múltiple identificó factores asociados con el retorno. Resultados predominó la asistencia a eventos clínicos, sexo masculino y edad media de 55,5 años. Se identificó un retorno del 26,7% a los seis meses de atención en el servicio prehospitalario. Las recaídas se asociaron con los factores clínicos de los pacientes, los procedimientos realizados en el ambiente prehospitalario móvil y el flujo intrahospitalario. También es posible verificar una relación con la región de la ciudad en la que se realizó el estudio. Conclusión e implicaciones para la práctica el análisis mostró un perfil de atención para pacientes con una edad promedio de 55 años y afectados por enfermedades crónicas no transmisibles. La posibilidad de retorno se asoció con la naturaleza clínica de la enfermedad, los flujos de atención y la región de atención. Estudios como este ayudan en la planificación y elaboración de políticas públicas y acciones de salud acordes con las necesidades identificadas, con el fin de reducir la sobrecarga de los servicios de emergencia.
Abstract Objective to analyze the factors associated with readmission to the Mobile Emergency Care Service. Method this is an epidemiological, cross-sectional study. Data from 600 adult patients served by the service in a municipality in the countryside of São Paulo, Brazil, in 2015 were analyzed. Multiple logistic regression identified the factors associated with readmission. Results clinical occurrences, male sex, and a mean age of 55.5 years predominated. A 26.7% return rate within six months of prehospital service was identified. Readmissions were associated with patients' clinical factors, procedures performed in the mobile prehospital environment, and intra-hospital flow. Additionally, a relationship with the region of the city where the study was conducted was observed. Conclusion and implications for the practice the analysis revealed a profile of patients with a mean age of 55 years and afflicted by chronic non-communicable diseases. The likelihood of return was associated with the clinical nature of the disease, care flows, and the service region. Studies similar to this one assist in planning and developing public policies and health actions in line with identified needs, aiming to reduce the burden on emergency services.
The present study was undertaken to determine anthropometrical parameters in male adult Wistar rats. We tested the hypothesis that the anthropometrical index may identify obesity and may predict its ...adverse effects on lipid profile and oxidative stress in rats. Two experimental protocols were performed. In the first experiment, 50 male Wistar rats, 21 days old and fed a control chow were studied up to 150 days of age. In the second experiment, male Wistar rats, 60 days old, were divided into three groups (n = 8): control (C) given free access to a control chow; (S) receiving the control chow and drinking 30% sucrose ad libitum and (HC) fed a high-carbohydrate diet ad libitum. The first experiment showed that food consumption, energy intake and body weight increased with increasing age, while specific rate of body mass gain was significantly decreased. There were no significant differences in body length and thoracic circumference of rats from 60 days of age. The abdominal circumference (AC) and body mass index (BMI) significantly increased with enhancing age in rats up to 90 days of age and remained constant thereafter. In the second experiment, after 30 days of dietary treatment, the final body weight, body mass gain, carcass fat and BMI were higher in S and HC rats than in C. There were no significant alterations in body length and carcass protein among the groups. Triacylglycerol (TG), total cholesterol (CT), low-density lipoprotein cholesterol (LDL-C) and lipid hydroperoxide (LH) were higher in S and HC rats than in C. High-density lipoprotein cholesterol (HDL-C) decreased in HC rats and total antioxidant substances (TAS) decreased in S and HC rats. There were positive correlations between BMI with carcass fat, BMI with LH and BMI and serum TG concentration. In conclusion, the BMI for male adult Wistar rats ranged between 0.45 and 0.68 g/cm2. Obesity may be easily estimated from the BMI in rats. Alterations in BMI were associated with dyslipidemic profile and oxidative stress in serum of rats and BMI may predict these adverse consequences of the obesity in rats.
The beneficial action of moderate wine consumption is increasingly being attributed to resveratrol (trans-3,4′,5-trihydroxystilbene). To test the safety of resveratrol use as a dietary supplement, 24 ...male Wistar rats were initially divided into three groups: (C, n=6) was given standard chow and water; (R, n=6) received standard chow and 6mg/l resveratrol in its drinking water (1mg/kg/day), and (HFD, n=12) received high-fat diet and water. In order to more appropriately study the effects of resveratrol on high-fat diet, after 30 days of treatments, HFD-rats were divided into two subgroups (n=6/group):(HFD) remained receiving high-fat diet and water; (HFD-R) given high-fat diet and 6mg/l resveratrol in its drinking water (1mg/kg/day). The total experimental period was 45 days. The resveratrol dose took into account its average concentration in wine, the time variability of wine ingestion, and so of resveratrol consumption in humans. HFD-rats had hyperglycaemia, dyslipidemia, increased serum oxidized-LDL (ox-LDL) and hepatic oxidative stress. Comparing HFD-R and HFD-rats, resveratrol improved lipid profile and glucose level, enhanced superoxide dismutase, thus reducing ox-LDL and hepatic oxidative stress. Resveratrol, in standard-fed-rats reduced glutathione-antioxidant defense system and enhanced hepatic lipid hydroperoxide. In conclusion, based on the results of this single dose preliminary study with resveratrol in the drinking water of male Wistar rats for 30 days, it may be concluded that resveratrol may have beneficial effects in high-fat diets (e.g. ox-LDL, decreased serum and hepatic oxidativestress), but not in standard-fed diets (effects produced include enhanced hepatic oxidative stress). Further studies are indicated.
Highlights • Foxg1 haploinsufficiency causes impairment of mouse and human visual function. • Foxg1+/Cre mice show defects in the visual cortex excitatory/inhibitory circuits. • FOXG1 -related visual ...alterations are compatible with the blind-sight syndrome.
To evaluate the impact of emerging myopathies on meat quality and microbial shelf life, 48 normal, 48 white striped (WS), and 48 wooden breasts (WB) were stored for 11 d at 4°C aerobically and ...analyzed at 24, 72, 120, 168, 216, and 264 h post-mortem. Normal breasts showed lower (P < 0.001) redness index (-0.88 vs. -0.41 and -0.43) and cooking losses (22.0 vs. 23.8 vs. 26.9%) than those of WS and WB meat. Normal and WS breasts exhibited higher protein content than that in WB meat (23.9 and 23.2 vs. 21.4%; P < 0.001). Normal meat also had a lower ether extract content than that in WB meat (1.09 vs. 1.88%; P < 0.001), with intermediate values for WS meat. Normal breasts exhibited higher saturated fatty acid (FA) rate (31.3 vs. 28.0% of total FA on average) and lower unsaturated FA rate (68.7 vs. 72.0%) than those in WS and WB meat (P < 0.001). Differences were mainly due to polyunsaturated FA (30.5% in normal vs. 35.3 and 35.4% in WS and WB meat; P < 0.001). Normal breasts had higher initial total viable count (TVC) and a shorter TVC lag phase than those of WS and WB meat (46.3 vs. 85.2 and 77.8 h). The microbial shelf life threshold (7 log10 CFU TVC/g) was achieved first in normal (130 h) and then in WS (149 h) and WB (192 h) meat. TVC and Pseudomonas spp. counts were significantly higher in normal than those in the affected breasts between 72 and 216 h of storage. Enterobacteriaceae spp. and lactic acid bacteria counts were significantly higher in normal meat, lower in WB meat, and intermediate in WS meat until 216 h. All differences in microbial targets across meat types disappeared by 264 h of storage. Further studies are necessary to elucidate the factors and the mechanisms that may modulate microbial growth and composition during storage in broiler breast meat affected by myopathies.
Introduction: A pulmonary embolism (PE) is a leading cause of mortality in hospitalized patients, yet the prevalence of PE in sickle cell disease (SCD) and its relation to disease severity or ...intrinsic hypercoagulability are not established.
Methods: We estimated inpatient PE incidence and prevalence among SCD and non‐SCD populations in Pennsylvania, and compared severity of illness and mortality, using Pennsylvania Health Care Cost Containment Council (PHC4) discharge data, 2001–2006. Risk factors for PE were assessed in a case–control study of discharges from the University of Pittsburgh Medical Archival Records System (MARS).
Results: The incidence of inpatient PE was higher in the SCD PA population than in the non‐SCD Pennsylvania population, 2001–2006. The PE prevalence among SCD discharges ≤ 50 years of age, 0.57%, was similar to that in non‐SCD Pennsylvania discharges, 0.60%, and unchanged after adjustment for race. Among SCD discharges, those developing PE were significantly older, with a longer length of stay, greater severity of illness and higher mortality, P < 0.001, than SCD without a PE. Among PE discharges, SCD had a similar severity of illness, P = 0.77, and mortality, P = 0.39, but underwent fewer computerized tomographic scans, P = 0.006, than non‐SCD with PE. In the local case–control study, no clinical or laboratory feature was associated with PE.
Conclusions: The incidence of PE is higher and chest computed tomography (CT) utilization is lower in SCD than non‐SCD inpatients, suggesting that PE may be under‐diagnosed.
Aim
The percentage recurrence after any surgical treatment for low rectovaginal fistula (LRVF) is unacceptably high. The aim of this study was to evaluate the short‐ and long‐term results of the ...Martius procedure in a carefully selected series of patients with a LRVF of at least 1 cm diameter who had had at least two previous surgeries or in the presence of chronically inflamed local tissues.
Method
Between January 2009 and April 2017, 24 patients with the abovementioned features were prospectively included in this study. Success was defined both as the absence of any subjective symptoms and the fistula, as confirmed by evaluation under anaesthesia. Postoperative complications were assessed using the Clavien–Dindo classification. Quality of life (SF‐12 score), quality of sexual life Female Sexual Function Index (FSFI) score and continence Cleveland Clinic Incontinence Score (CCIS) were also determined pre‐ and postoperatively.
Results
The mean follow‐up was 42 ± 29 months (range 3–101 months). The overall success rate was 91.3% (22/24 patients). The median operation time was 50 min (range 45–70 min), and the median hospital stay was 3.5 days (range 3–5 days). No major complications occurred. Pre‐ and postoperative CCIS did not differ 1 (range 0–3.5). The postoperative SF‐12 score improved both in terms of the physical (33.6 ± 7.2 vs 50.8 ± 7.8; P < 0.001) and mental (32.6 ± 6.7 vs 56.3 ± 7.8; P < 0.001) components. FSFI improved from 19.5 ± 6.6 to 24.4 ± 6.3 (P < 0.001).
Conclusion
The Martius procedure should be considered as the first‐line method of treatment in carefully selected cases of LRVF.
Heart failure with preserved ejection fraction ≥50% is prevalent with few evidence-based therapies. In a trial of patients with heart failure with preserved ejection fraction with specialized ...pacemakers, treatment with accelerated personalized pacing averaging 75 bpm (myPACE) markedly improved quality of life, NT-proBNP (N-terminal pro-brain natriuretic peptide), physical activity, and atrial fibrillation burden compared with the standard lower rate setting of 60 bpm (usual care).
In this exploratory study, provider-initiated echocardiographic studies obtained before and after the trial were assessed for changes in left ventricular (LV) structure and function among participants who continued their pacing assignment. The analytic approach aimed to detect differences in standard and advanced echocardiographic parameters within and between study arms. Of the 100 participants, 16 myPACE and 20 usual care arm had a qualifying set of echocardiograms performed a mean (SD) 3 (2.0) years apart. Despite similar baseline echocardiogram measures, sustained exposure to moderately accelerated pacing resulted in reduced septal wall thickness (in cm: myPACE 1.1 0.2 versus usual care 1.2 0.2,
=0.008) and lower LV mass to systolic volume ratio (in g/mL: myPACE 4.8 1.9 versus usual care 6.8 3.1,
=0.038) accompanied by a minor reduction in LV ejection fraction (in %: myPACE 55 5 versus usual care 60 5,
=0.015). These changes were paralleled by improvements in heart failure-related quality of life (myPACE Minnesota Living with Heart Failure Questionnaire improved by 16.1 13.9 points, whereas usual care worsened by 6.9 11.6 points,
<0.001). Markers of diastolic function and LV performance were not affected.
Exposure to continuous accelerated pacing in heart failure with preserved ejection fraction is associated with a reduced LV wall thickness and a small amount of LV dilation with small reduction in ejection fraction.
The relevant change in land use due mainly to the rapid expansion of soybean cropping towards areas traditionally occupied for livestock purposes or with native grasslands of South America may have ...negative consequences on soil organic carbon (SOC) storage and aggregate stability, although the effect may be different between soils with contrasting aggregation agents. The aim of our work was to assess the impact of the land use, measured as the intensification and/or frequency of a given crop, on SOC storage and aggregate stability in two soils differing in their main agents of aggregation. The study was conducted in a Mollisol and a Vertisol of Argentina. Eleven cropped fields (agricultural and crop–pasture rotation) under no-tillage and one uncropped situation (pristine native grassland) were selected in each soil type. The fraction of annual time with plant cover (as a measure of the intensification in the land use) and the frequency of a given crop in the cropping sequence over a 6-year period were calculated. Undisturbed soil samples were collected from each soil at 0–5, 5–15 and 15–30cm depths. The SOC stocks in equivalent soil mass were calculated using the native grassland as the baseline system. Aggregate stability was evaluated using a method that involved three pretreatments: fast wetting, stirring after prewetting and slow wetting. The intensification improved the aggregate stability in the Mollisol, whereas a low impact of land use on aggregate stability was recorded in the Vertisol. Overall, both the intensification sequence index and the soybean cropping frequency were the best indexes to evaluate the impact of land use on aggregate stability and SOC storage, mainly in the Mollisol. The stirring after prewetting pretreatment was mainly associated with SOC concentration in the Mollisol, appearing as a method with high potential capacity to discriminate land use in the Mollisol, in which the SOC is the main aggregation agent. In contrast, the slow wetting pretreatment was more appropriate to evaluate the impact of land use in the Vertisol. The approach used to evaluate the land use, which included agricultural lands, crop–pasture rotation and native grasslands, evaluated through indexes of occupation with plant cover, was more suitable for the Mollisol than for the Vertisol. This reveals that the evaluation of land use through several indexes should be based on the soil type.
► The intensification improves the aggregate stability and SOC stock in the Mollisol. ► The aggregate stability was higher in the Vertisol than in the Mollisol. ► The aggregate stability was closely related with SOC concentration in the Mollisol. ► Indexes of occupation with plant cover were suitable to evaluate the land use.
Background
The aim of the present study was to evaluate the efficacy and safety of 3% polidocanol foam for treating 2nd-degree haemorrhoids.
Methods
A multicentre, open-label, single-arm, phase 2 ...trial involving 10 tertiary referral centres for haemorrhodal disease (HD) was performed. Between January and June 2019, patients with 2nd-degree haemorrhoids were prospectively included in this study. The primary outcome was to establish the success rate after one sclerotherapy session in terms of complete resolution of bleeding episodes one week after the injection. The Hemorrhoidal Disease Symptom Score (HDSS), the Short Health Scale for HD (SHS-HD) score and the Vaizey incontinence score were used to assess symptoms and their impact on quality of life and continence. Pain after the procedure, subjective symptoms and the amount and type of painkillers used were recorded. Patients were followed up for 1 year.
Results
There were 183 patients 111 males; 60.7%, mean age 51.3 ± 13.5 (18–75) years. Complete resolution of bleeding was reached in 125/183 patients (68.3%) at 1 week and the recurrence rate was 12% (15/125).
Thirteen patients (7.4%) underwent a second sclerotherapy session, while only 1 patient (1.8%) had to undergo a third session. The overall 1-year success rate was 95.6% (175/183). The HDSS and the SHS score significantly improved from a median preoperative value of 11 and 18 to 0 and 0, respectively (
p
< 0.001). There were 3 episodes of external thrombosis. No serious adverse events occurred.
Conclusions
Sclerotherapy with 3% polidocanol foam is a safe, effective, painless, repeatable and low-cost procedure in patients with bleeding haemorrhoids.
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