Camila Sardenberg

Balance between cytokine production by peripheral blood mononuclear cells and reactive oxygen species production by monocytes in patients with chronic kidney disease.

Hemodialysis (HD) and peritoneal dialysis are associated with inflammatory events and immunological incompetence. The purpose of this study was to evaluate the effect of both uremia and dialysis modality on the production of cytokines and reactive oxygen species (ROS) by monocytes. four groups of subjects were studied: 28 chronic kidney disease (CKD) patients, 14 chronic HD patients, 14 patients on continuous ambulatory peritoneal dialysis (CAPD) patients, and 14 healthy volunteers. peripheral blood mononuclear cells (PBMC) were isolated from blood samples and incubated for 24 hr with or without lipopolysaccharide (LPS). TNF‐α and IL‐10 production by PBMC and serum levels of these cytokines were quantified by ELISA. Aliquots of whole blood were incubated in vitro and ROS production and phagocytosis were quantified by flow cytometry. Compared to the control group, Staphylococcus aureus–stimulated ROS production by monocytes was significantly lower in the HD group. The highest levels of unstimulated TNF‐α production in vitro were observed in the HD group. In the CKD group, as well as in the whole population, there were a negative correlation between TNF‐α production by unstimulated PBMC and ROS production by S. aureus–stimulated monocytes and a positive correlation between PMA‐stimulated ROS production by monocytes and unstimulated and LPS‐stimulated IL‐10 production by PBMC suggesting that the pro‐inflammatory state in CKD patients is associated with decreased response to infectious challenges.

Reduced frequency of cardiopulmonary arrests by rapid response teams

OBJECTIVE To evaluate the impact of the implementation of a rapid response team on the rate of cardiorespiratory arrests in mortality associated with cardiorespiratory arrests and on in-hospital mortality in a high complexity general hospital. METHODS A retrospective analysis of cardiorespiratory arrests and in-hospital mortality events before and after implementation of a rapid response team. The period analyzed covered 19 months before intervention by the team (August 2005 to February 2007) and 19 months after the intervention (March 2007 to September 2008). RESULTS During the pre-intervention period, 3.54 events of cardiorespiratory arrest/1,000 discharges and 16.27 deaths/1,000 discharges were noted. After the intervention, there was a reduction in the number of cardiorespiratory arrests and in the rate of in-hospital mortality; respectively, 1.69 events of cardiorespiratory arrest/1,000 discharges (p < 0.001) and 14.34 deaths/1,000 discharges (p = 0.029). CONCLUSION The implementation of the rapid response team may have caused a significant reduction in the number of cardiorespiratory arrests. It was estimated that during the period from March 2007 to September 2008, the intervention probably saved 67 lives.

Impacto do uso da pinça seladora ou do bisturi harmônico nos desfechos intra-hospitalares e no custo de procedimentos de tireoidectomia

OBJECTIVES To analyze the operative time, length of hospitalization and cost, as well as the bleeding and pain observed during the postoperative period, of thyroidectomy procedures using vessel sealing, harmonic scalpel or the conventional technique. METHODS Retrospective analysis of thyroidectomies performed between 2007 and 2010 using either the conventional technique or minimally invasive techniques involving vessel sealing or a harmonic scalpel. Gender, age, primary diagnosis and procedure type were analyzed. The outcomes analyzed included the length of the procedure, length of hospital stay, need for blood product transfusions, pain and cost of hospitalization. The findings were based on a significance level of 5%, and statistical analyses were performed using the R software. RESULTS The use of the vessel sealing increased the duration of the surgery by approximately 47 minutes compared to the conventional technique (p<0.001), and the use of the harmonic scalpel decreased the duration of the surgery by approximately 32 minutes compared to the conventional technique (p<0.001). No statistically significant difference was found between the groups regarding the use of blood products and pain score. Procedures involving vessel sealing or a harmonic scalpel cost more than those using the conventional technique. CONCLUSION The use of harmonic scalpel was favorable in terms of reducing the surgical time, but there was no reduction in hospitalization time. The cost of the procedure was higher than that of the conventional technique. The use of vessel sealing offered no advantages in terms of the outcomes assessed, and the cost of the procedure was greater than that of the conventional technique.

Association between participation and compliance with Continuing Medical Education and care production by physicians: a cross-sectional study

Objective Physician participation in Continuing Medical Education programs may be influenced by a number of factors. To evaluate the factors associated with compliance with the Continuing Medical Education requirements at a private hospital, we investigated whether physicians’ activity, measured by volumes of admissions and procedures, was associated with obtaining 40 Continuing Medical Education credits (40 hours of activities) in a 12-month cycle. Methods In an exclusive and non-mandatory Continuing Medical Education program, we collected physicians’ numbers of hospital admissions and numbers of surgical procedures performed. We also analyzed data on physicians’ time since graduation, age, and gender. Results A total of 3,809 credentialed, free-standing, private practice physicians were evaluated. Univariate analysis showed that the Continuing Medical Education requirements were more likely to be achieved by male physicians (odds ratio 1.251; p=0.009) and who had a higher number of hospital admissions (odds ratio 1.022; p<0.001). Multivariate analysis showed that age and number of hospital admissions were associated with achievement of the Continuing Medical Education requirements. Each hospital admission increased the chance of achieving the requirements by 0.4%. Among physicians who performed surgical procedures, multivariate analysis showed that male physicians were 1.3 time more likely to achieve the Continuing Medical Education requirements than female physicians. Each surgical procedure performed increased the chance of achieving the requirements by 1.4%. Conclusion The numbers of admissions and number of surgical procedures performed by physicians at our hospital were associated with the likelihood of meeting the Continuing Medical Education requirements. These findings help to shed new light on our Continuing Medical Education program.

Bloodstream Infection in the Intensive Care Unit: Preventable Adverse Events and Cost Savings

OBJECTIVES Central line associated bloodstream infections (CLABSIs) impose a significant economic burden for patients admitted to the intensive care unit for adults (AICU). The objectives of the study were to evaluate the excess length of stay and extra costs attributable to CLABSIs diagnosed in the AICU. METHODS Cases were selected as patients admitted to AICU from 2006 through 2009, who developed a CLABSI episode. These were matched (1:1) with appropriate controls. Matching criteria were selected to exclude other factors that could influence cost and care practices. The length of stay and resources used between AICU admission and discharge and until hospital discharge or death were measured. Incremental costs and lengths of stay were calculated for each pair of patients. RESULTS Thirty cases and 30 controls were included in the study. A CLABSI episode resulted in an additional 10.5 days in the AICU and 9.1 days after AICU discharge, totaling an additional 19.6 days. The incremental cost associated with a CLABSI episode was US

Impact of treatment modality, biochemical parameters and apoptosis on polymorphonuclear cell (PMN) function in patients with renal failure

65,993 in the AICU and US

Effects of uraemia and dialysis modality on polymorphonuclear cell apoptosis and function

23,893 after AICU discharge, totaling an incremental cost of US

Soluble Fas: a novel marker of inflammation in uremia.

89,886. CONCLUSIONS By avoiding CLABSI events, cost offsets would be expected for payers with revenue losses to providers. An approach of sharing the gains resulting from preventive measures could be used to incentivize providers to maintain those investments, benefiting patients who will have a reduced risk of CLABSI development.

Índice de doenças coexistentes e idade avançada como preditores desobrevida em pacientes em diálise

It has been suggested that PMN apoptosis is increased in dialysis patients and may contribute to cellular dysfunction. We investigated the effect of treatment modality and biochemical parameters on PMN apoptosis and function. Blood was drawn from 17 controls, 17 patients with chronic renal failure (CRF; creatinine clearance 28 ± 14 ml/min/1.73 m2), 10 hemodialysis (HD) and 11 CAPD patients. Upon collection, whole blood aliquots were incubated in RPMI-1640 with propidium iodide (PI)-labeled Saureus (SA), PMA, fMLP or LPS for 30 min. Cells were then stained with DCFH-DA and analyzed by flow cytometry, in order to quantify phagocytosis and H2O2 release by PMN. After separation by gradient centrifugation, PMN were stained with Annexin-V and PI in order to quantify apoptosis by flow cytometry. The results were correlated with blood levels of urea, creatinine, bicarbonate, albumin and PTH. Results are presented as means ± SD. Among CRF and HD patients, there was an inverse correlation between apoptosis and SA- (r = 0.62, P = 0.01 and r = 0.89, P = 0.02, respectively) and LPS-stimulated H2O2 release (r = 0.68, P = 0.005 and r = 0.61, P = 0.058, respectively). No biochemical parameters correlated with apoptosis or cellular functions. In summary, PMN apoptosis contributes to cellular malfunction in uremia, but does not account for all the dysfunction. Hence, it is possible that other uremic toxins affect cell performance independently of apoptosis. Table