Abstract Background Although involvement of geriatricians in the care of older trauma patients is associated with changes in processes of care and improved outcomes, few geriatrician consultations ...were ordered on our service. Study Design Mandatory geriatric consults were initiated in Sept 2013 for all trauma patients 70 years and older admitted to our hospital. We prospectively collected data on patients admitted from Oct 2013–Sept 2014 (post-intervention) and compared to patients admitted from Jun 2011–Jun 2012 (pre-intervention). We collected data on processes of care (Do Not Resuscitate/ Do Not Intubate (DNR/DNI) status, delirium, referral for cognitive evaluation) and patient outcomes (mortality, readmission, length of stay). Descriptive statistics and post-hoc power analyses were performed. Results There were 215 and 191 patients included in the pre-intervention and post-intervention cohorts respectively. After the intervention, geriatric consults increased from 3.26% to 100%. Patients on DNR/DNI status increased from 10.23% to 38.22% ( P <0.01). Referral for formal cognitive evaluation increased from 2.33% to 14.21% ( P <0.01) and delirium documentation increased from 31.16% to 38.22% ( P= 0.14). In-hospital mortality and 30-day mortality in the pre- and post-intervention periods were 9.30% vs. 5.24% ( P =0.12) and 11.63% vs. 6.81% ( P =0.10) respectively. ICU readmission was 8.26% pre-intervention and 1.96% post-intervention ( P =0.06). There were no changes in 30-day hospital readmission and length of stay. Power analyses showed more patients were needed to show statistically significant outcomes. Conclusions The initiation of mandatory geriatric consults on our trauma service was associated with improved advance care planning and increased multidisciplinary care. Ensuring involvement of geriatricians may aid in reducing adverse outcomes among geriatric trauma patients.
Linear alkylbenzene sulfonate (LAS) is an anionic surfactant used in cleaning products, which is usually found in wastewaters. Despite the greater LAS removal rate related to a lower concentrations ...of volatile fatty acids (VFA), the influence of different ranges of VFA on LAS degradation is not known. LAS degradation was evaluated in upflow anaerobic sludge blanket (UASB) and expanded granular sludge bed (EGSB) reactors at different ranges of VFA concentrations. The reactors were fed with a synthetic wastewater containing LAS (14 mg/L). A greater LAS removal rate (40–80%) was related to the lower and narrower range of acetic acid concentration (1–22 mg/L) in the EGSB reactor. In the UASB reactor, the acetic acid concentrations presented a wider range (2–45 mg/L), and some low LAS removal rates (around 20–25%) were observed even at low acetic acid concentrations (<10 mg/L). The high recirculation rate in the EGSB reactor improved substrate-biomass contact, which resulted in a narrower range of VFA and greater LAS removal rate.
•The degradation of linear alkylbenzene sulfonate was evaluated.•The EGSB reactor presented the greater LAS degradation rate.•The efficiency of the EGSB reactor was related to its higher recirculation rate.•A smaller concentration of acetic acid was found in the effluent from the EGSB reactor.
The effect of a lipase-rich enzyme preparation produced by the fungus Penicillium sp. on solid-state fermentation was evaluated in two anaerobic bioreactors (up-flow anaerobic sludge blanket (UASB) ...and horizontal-flow anaerobic immobilized biomass (HAIB)) treating dairy wastewater with 1200 mg oil and grease/L. The oil and grease hydrolysis step was carried out with 0.1% (w/v) of the solid enzymatic preparation at 30°C for 24 h. This resulted in a final concentration of free acids eight times higher than the initial value. The bioreactors operated at 30°C with hydraulic retention times of 12 h (HAIB) and 20 h (UASB) for a period of 430 days, and had high chemical oxygen demand (COD) removal efficiencies (around 90%) when fed with pre-hydrolyzed wastewater. There was, however, an increase in the effluent oil and grease concentration (from values as low as 17 mg/L to values above 150 mg/L in the UASB bioreactor, and from 38–242 mg/L in the HAIB bioreactor), and oil and grease accumulation in the biomass throughout the operational period (the oil and grease content reached 1.7 times that found in the inoculum of the UASB bioreactor). The HAIB bioreactor gave better results because the support for biomass immobilization acted as a filter, retaining oil and grease at the entry of the bioreactor. The molecular analysis of the Bacteria and Archaea domains revealed significant differences in the microbial profiles in experiments conducted with and without the pre-hydrolysis step. The differences observed in the overall parameters could be related to the microbial diversity of the anaerobic sludge.
The present study aimed to characterization microscopic and chemical of four samples of fruit flours: eggplant (Solanum melongena), banana (Musa spp), passion fruit (Passiflora spp) and grape (Vitis ...vinifera). For the determination of chemical composition acid digestion was via a microwave-assisted using nitric acid and hydrogen peroxide and subsequently analysed by inductively coupled plasma Optical Emission Spectrometry (ICP OES). The validation of method was evaluated by analyzing a certified reference material (CRM), Rice Flour NIST 1568a. The vitamin C contents of the sample flour were determined by the AOAC procedure. The microscopic analyzes were realized with an optical microscope Olympus SZH10 coupled to a digital camera Cannon Power Shot A460. Average mineral concentration in flour samples (in mg/100 g) were: 0.30 to 367 (Ca); 3.38 to 1666 (K); 0.16 to 216 (Mg); 0.023 to 136 (Na); 0.010 to 9.95 (Cu); 0.050 to 27.87 (Fe); 0.052 to 6.55 (Mn); 0,011 to 6,04 (Zn) and 2,9 to 70,4 (Vitamin C). The principal component analysis (PCA) showed that the variables vitamin C and Na have negative correlation with Mn and these variables contribute to discrimination of samples of banana and passion fruit flour’s. Characteristic plant tissue components that compose the fruit flours were observed as well as the irregular addition of starch.
Early neuropathological changes characteristic of late-onset Alzheimer's disease (LOAD) involve brain stem and limbic structures that regulate neurovegetative functions, including sleep-wake rhythm. ...Indeed, sleep pattern is an emerging biomarker and a potential pathophysiological mechanism in LOAD. We hypothesized that cognitively asymptomatic, middle-aged offspring of patients with LOAD (O-LOAD) would display a series of circadian rhythm abnormalities prior to the onset of objective cognitive alterations. We tested 31 children of patients with LOAD (O-LOAD) and 19 healthy individuals without family history of Alzheimer's disease (control subjects, CS) with basic tests of cognitive function, as well as actigraphy measures of sleep-wake rhythm, cardiac autonomic function, and bodily temperature. Unexpectedly, O-LOAD displayed subtle but significant deficits in verbal episodic memory (Rey Auditory Verbal Learning Test delayed recall 10.6 ± 0.4 vs. 8.6 ± 0.6,
= 4.97,
= 49,
< 0.01) and language (Weschler's vocabulary 51.4 ± 1.3 vs. 44.3 ± 1.5,
= 2.49,
= 49,
< 0.001) compared to CS, even though all participants had results within the clinically normal range. O-LOAD showed a phase-delayed rhythm of body temperature (2.56 ± 0.47 h vs. 3.8 ± 0.26 h,
= 2.48,
= 40,
= 0.031). Cognitive performance in O-LOAD was associated with a series of cardiac autonomic sleep-wake variables; specifically indicators of greater sympathetic activity at night were related to poorer cognition. The present results suggest sleep pattern deserves further study as a potential neurobiological signature in LOAD, even in middle-aged, at risk individuals.
Cardiovascular-Active Venom Toxins: An Overview Rebello Horta, Carolina Campolina; Chatzaki, Maria; Rezende, Bruno Almeida ...
Current medicinal chemistry,
01/2016, Letnik:
23, Številka:
6
Journal Article
Recenzirano
Animal venoms are a mixture of bioactive compounds produced as weapons and used primarily to immobilize and kill preys. As a result of the high potency and specificity for various physiological ...targets, many toxins from animal venoms have emerged as possible drugs for the medication of diverse disorders, including cardiovascular diseases. Captopril, which inhibits the angiotensin-converting enzyme (ACE), was the first successful venom-based drug and a notable example of rational drug design. Since captopril was developed, many studies have discovered novel bradykinin-potentiating peptides (BPPs) with actions on the cardiovascular system. Natriuretic peptides (NPs) have also been found in animal venoms and used as template to design new drugs with applications in cardiovascular diseases. Among the anti-arrhythmic peptides, GsMTx-4 was discovered to be a toxin that selectively inhibits the stretch-activated cation channels (SACs), which are involved in atrial fibrillation. The present review describes the main components isolated from animal venoms that act on the cardiovascular system and presents a brief summary of venomous animals and their venom apparatuses.
Abstract
To evaluate disease characteristics of childhood onset SLE in Latin America and to compare this information with an adult population in the same cohort of GLADEL. A protocol was designed as ...a multicenter, multinational, inception cohort of lupus patients to evaluate demographic, clinical, laboratory and serological variables, as well as classification criteria, disease activity, organ damage and mortality. Descriptive statistics, chi square, Fisher's exact test, Student's t test and multiple logistic regression were used to compare childhood and adult onset SLE. 230 patients were < 18 years and 884 were adult SLE patients. Malar rash, fever, oral ulcers, thrombocytopenia and hemolytic anemia and some neurologic manifestations were more prevalent in children (p < 0.05). On the other hand, myalgias, Sjögren’s syndrome and cranial nerve involvement were more frequently seen in adults (p < 0.05). Afro-Latin-American children had a higher prevalence of fever, thrombocytopenia and hemolytic anemia. White and mestizo children had a higher prevalence of malar rash. Mestizo children had a higher prevalence of cerebrovascular disease and cranial nerve involvement. Children met SLE ACR criteria earlier with higher mean values than adults (p: 0.001). They also had higher disease activity scores (p: 0.01), whereas adults had greater disease damage (p: 0.02). In Latin America, childhood onset SLE seems to be a more severe disease than adults. Some differences can be detected among ethnic groups.
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