Tiemi Matsuo

Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study

IntroductionWhen the number of patients who require intensive care is greater than the number of beds available, intensive care unit (ICU) entry flow is obstructed. This phenomenon has been associated with higher mortality rates in patients that are not admitted despite their need, and in patients that are admitted but are waiting for a bed. The purpose of this study is to evaluate if a delay in ICU admission affects mortality for critically ill patients.MethodsA prospective cohort of adult patients admitted to the ICU of our institution between January and December 2005 were analyzed. Patients for whom a bed was available were immediately admitted; when no bed was available, patients waited for ICU admission. ICU admission was classified as either delayed or immediate. Confounding variables examined were: age, sex, originating hospital ward, ICU diagnosis, co-morbidity, Acute Physiology and Chronic Health Evaluation (APACHE) II score, therapeutic intervention, and Sequential Organ Failure Assessment (SOFA) score. All patients were followed until hospital discharge.ResultsA total of 401 patients were evaluated; 125 (31.2%) patients were immediately admitted and 276 (68.8%) patients had delayed admission. There was a significant increase in ICU mortality rates with a delay in ICU admission (P = 0.002). The fraction of mortality risk attributable to ICU delay was 30% (95% confidence interval (CI): 11.2% to 44.8%). Each hour of waiting was independently associated with a 1.5% increased risk of ICU death (hazard ratio (HR): 1.015; 95% CI 1.006 to 1.023; P = 0.001).ConclusionsThere is a significant association between time to admission and survival rates. Early admission to the ICU is more likely to produce positive outcomes.

Prevalência e caracterização da dor crônica em idosos não institucionalizados

Os objetivos deste estudo foram: determinar a prevalencia da dor cronica em idosos servidores municipais e caracterizar esta dor quanto ao local, intensidade, duracao, frequencia do episodio e horario preferencial. Estudo transversal de base populacional realizado em area urbana de Londrina, Parana, Brasil. A populacao pesquisada foi de 451 idosos servidores municipais. A coleta de dados foi realizada por entrevista domiciliar, aplicada ao idoso. Considerou-se dor cronica toda dor com duracao igual ou superior a seis meses, e idoso, todo servidor com mais de sessenta anos. Constatou-se prevalencia de dor cronica de 51,44%. Os locais de dores mais frequentes foram: regiao dorsal (21,73%) e membros inferiores (21,5%). A dor em regiao dorsal foi descrita como diaria (31,63%), continua ou com duracao entre 1 e 6 horas (19,39%), leve (50%) e sem horario preferencial (56,12%). Dor em membros inferiores foi descrita como diaria (42,27%), com duracao variavel (32,99%) ou continua (22,68%), leve (53,61%) e sem horario preferencial (48,45%). Evidenciou-se alta prevalencia de dor cronica em idosos. As caracteristicas da dor observadas podem interferir na qualidade de vida dessa populacao, impondo sofrimento desnecessario.

Uremic hyperhomocysteinemia: a randomized trial of folate treatment for the prevention of cardiovascular events.

Homocysteine is a risk factor for atherosclerosis in the general population, and serum homocysteine levels are almost universally elevated in chronic renal failure patients. When such patients are treated with dialysis, cardiovascular disease accounts for more than 50% of their mortality, which, in some proportion, may be pathophysiologically related to the elevated serum homocysteine levels. From April 2003 to March 2005, we conducted a 2‐year, double‐blind, randomized, placebo‐controlled trial of 186 patients with end‐stage kidney disease due to any cause, who were older than 18 years and stable on hemodialysis. Patients were assigned to receive either oral folic acid 10 mg 3 times a week immediately after every dialysis session under nurse supervision or an identical‐appearing placebo for the entire study. On admission, plasma total homocysteine (tHcy) levels were above 13.9 μmol/L in 96.7% of patients (median 25.0 μmol/L, range 9.3–104.0 μmol/L). In the placebo group, tHcy levels remained elevated at 6, 12, and 24 months, while oral folate significantly decreased tHcy to a median value of 10.5 (2.8–20.3) μmol/L, (p<0.01). During the study, 38 patients (folic acid group 17 vs. placebo group 21; p=0.47) died from cardiovascular disease. Kaplan–Meier life table analysis dealing with the incidence of cardiovascular events, both fatal and nonfatal (myocardial infarction, arrhythmias, angina, heart failure, cerebrovascular accident), showed that 2 years of folic acid treatment and the lowering of the homocysteine blood levels had no effect on cardiovascular events (p=0.41; hazard ratio 1.24, 95% CI 0.74–2.10). However, the carotid artery intima‐media wall thickness measured in a blinded fashion decreased from 1.94 ± 0.59 mm to 1.67 ± 0.38 mm (p<0.01) after 2 years of folate therapy. In this short‐term study of uremic patients, 2 years of folic acid supplementation normalized the tHcy blood levels in 92.3% of patients but did not change the incidence of cardiovascular events compared with the control group. However, ultrasonography of the common carotid arteries performed at entry and 24 months later showed a significant decrease in intima‐media thickness with folate supplementation. This suggests that early folate supplementation may benefit patients with chronic renal failure by preventing cardiovascular deterioration.

Hipertensão como fator associado à perda auditiva

OBJETIVO: Identificar possivel associacao entre hipertensao arterial e perda auditiva. Foi realizado um estudo do tipo caso-controle nao pareado, na Universidade Norte do Parana, no Sul do Brasil. MATERIAL E METODO: 154 casos e 154 controles, de ambos os sexos com idade variando de 45 a 64 anos foram incluidos na pesquisa apos o calculo da amostra. A hipertensao foi verificada por medicao da pressao arterial e de questionario sistematizado sobre hipertensao e uso de medicamentos para pressao arterial. A audicao foi avaliada por audiometria e anamnese audiologica. A tecnica de regressao logistica nao-condicional foi utilizada com o objetivo de controlar a possivel acao de confusao ou modificacao de efeito exercida por outras variaveis sobre as associacoes de interesse. RESULTADOS : Pode-se verificar que existe associacao significativa entre hipertensao arterial e presenca de perda auditiva e que a perda auditiva observada nesta populacao sugere que a hipertensao arterial age como fator de aceleracao da degeneracao do aparelho auditivo proveniente da idade. CONCLUSOES: Os resultados da presente pesquisa, atraves da constatacao da associacao entre hipertensao e perda auditiva, servirao de base a uma integracao entre cardiologistas, nefrologistas, otorrinolaringologistas, fonoaudiologos e outros profissionais da area de com alteracoes provenientes da hipertensao.

Vehicle thermal microclimate evaluation during Brazilian summer broiler transport and the occurrence of PSE (Pale, Soft, Exudative) meat

O microambiente termico formado no caminhao de transporte de frangos da granja ao abatedouro pode ser a causa primaria que compromete o bem estar das aves e a qualidade final da carne com o desenvolvimento de PSE (Pale, Soft, Exudative) em files de peito de frango. O objetivo deste trabalho foi avaliar o efeito do microambiente formado durante o transporte por caminhao em uma linha comercial. Para classificacao de files de peito em PSE, o pH e a cor (L*, a* e b*) foram medidos nos files de peito de frango 24 h postmortem. Os resultados mostraram que em jornadas longas, as aves transportadas nas regioes do meio e fundo do veiculo apresentaram maior ocorrencia de PSE devido as dramaticas condicoes de temperatura e umidade relativa no microambiente destas regioes. A ventilacao diminuiu gradualmente da frente a trazeira do caminhao e a aplicacao do banho de agua sobre os frangos apos o carregamento na granja foi benefica em jornadas longas ao reduzir a ocorrencia de carnes PSE.

Seroprevalence for hepatitis E virus (HEV) infection among volunteer blood donors of the Regional Blood Bank of Londrina, State of Paraná , Brazil

A cross-sectional study was carried out among 996 volunteer blood donors enrolled from May 1999 to December 1999 to determine the seroprevalence of hepatitis E virus (HEV) infection among volunteer blood donors of the Regional Blood Bank of Londrina, State of Paraná, Brazil, and to evaluate whether the rate of seroprevalence of IgG anti-HEV antibodies is associated with sociodemographic variables and with seropositivity for hepatitis A virus (HAV) infection. All participants answered the questionnaire regarding the sociodemographic characteristics. Serum samples were tested for IgG antibodies to HEV (anti-HEV) by an enzyme linked immunoassay (ELISA). All serum samples positive for anti-HEV IgG and 237 serum samples negative for anti-HEV were also assayed for IgG anti-HAV antibodies by ELISA. Anti-HEV IgG was confirmed in 23/996 samples, resulting in a seroprevalence of 2.3% for HEV infection, similar to previous results obtained in developed countries. No significant association was found between the presence of anti-HEV IgG antibodies and the sociodemographic variables including gender, age, educational level, rural or urban areas, source of water, and sewer system (p > 0.05). Also, no association with seropositivity for anti-HAV IgG antibodies was observed (p > 0.05). Although this study revealed a low seroprevalence of HEV infection in the population evaluated, the results showed that this virus is circulating among the population from Londrina, South Brazil, and point out the need of further studies to define the clinical and epidemiological importance of HEV infection and to identify additional risk factors involved in the epidemiology and pathogenesis of this infection in this population.

Características clínicas e qualidade de vida de fumantes em um centro de referência de abordagem e tratamento do tabagismo

OBJETIVO: Comparar, entre fumantes e nunca fumantes, os seguintes aspectos: qualidade de vida, IMC, hospitalizacoes, incapacidades, historia familiar de transtorno mental, doencas relacionadas ao uso de tabaco, depressao e uso de substâncias psicoativas. METODOS: Um total de 167 fumantes inscritos em um programa de cessacao do tabagismo no Centro de Referencia de Abordagem e Tratamento do Tabagismo da Universidade Estadual de Londrina e 272 nunca fumantes doadores de sangue foram incluidos no estudo. Foram utilizados um questionario estruturado para a coleta de dados sociodemograficos, Alcohol, Smoking and Substance Involvement Screening Test, World Health Organization Quality of Life Instrument, brief version (WHOQoL-BREF) e Fagerstrom Test for Nicotine Dependence, todos validados para uso no Brasil, assim como criterios diagnosticos para a pesquisa de transtornos depressivos. RESULTADOS: A media de idade para fumantes e nunca fumantes foi, respectivamente, de 45 e 44 anos. As mulheres predominaram nos dois grupos. Fumantes mais frequentemente apresentaram incapacidades laborais e domesticas, presenca de fumantes em casa, hospitalizacoes, transtorno depressivo, uso de sedativos, historia de transtorno mental na familia e piores escores em todos os dominios do WHOQoL-BREF. A media de idade do inicio do tabagismo em fumantes com depressao ou em uso de substâncias psicoativas foi mais baixa do que os sem essas comorbidades. Fumantes apresentaram mais frequentemente diabetes, hipertensao arterial, doencas cardiacas, doencas respiratorias e ulcera peptica do que os que nunca fumaram. O IMC medio foi menor entre fumantes do que nos que nunca fumaram. CONCLUSOES: Este estudo sugere que, no tratamento do tabagismo, deveriam ser identificados subgrupos de fumantes com caracteristicas especificas: inicio precoce do tabagismo, doencas que sofrem agravos pelo tabaco, depressao e uso de substâncias psicoativas.

Hypertension as a factor associated with hearing loss

AIM To identify likely association between blood hypertension and hearing loss. DESIGN A non-paired case-control study. SETTING Institutional work carried out at Universidade Norte do Paraná, in South Brazil. MATERIAL AND METHOD 154 cases and 154 controls, both genders, aged 45 to 64, included in the research after sample estimation. METHODOLOGY Hypertension was verified through blood pressure readings and by a systematized questionnaire about hypertension and the use of medication for blood pressure. Hearing was assessed through tonal threshold audiometrics and audiologic anamneses. Non-conditional logistic regression was used in order to control likely confusion or modification of effect of other variables on interest associations. RESULTS There is a significant association between blood hypertension and hearing loss. Hearing loss in the population under study suggests that hypertension is an accelerating factor of degeneration of the hearing apparatus due to aging. CONCLUSIONS The results in this research, through evidence of association between blood hypertension and hearing loss, can allow for an integrated work of cardiologists, nephrologists, otorhinolaryngologists, audiologists and other health professionals concerned with alterations caused by blood hypertension.

CXCL12 rs1801157 Polymorphism in Patients with Breast Cancer, Hodgkin's Lymphoma, and Non-Hodgkin's Lymphoma

Chemokines and their receptors regulate the trafficking of immune cells during their development, inflammation, and tissue repair. The single‐nucleotide polymorphism (SNP) rs1801157 (previously known as CXCL12‐A/ stromal cell‐derived factor‐1 (SDF1)‐3′A) in CXCL12/SDF1 gene was assessed in breast cancer, Hodgkins lymphoma (HL), and non‐Hodgkins lymphoma (NHL), since the chemokine CXCL12, previously known as SDF1, and its receptor CXCR4 regulate leukocyte trafficking and many essential biological processes, including tumor growth, angiogenesis, and metastasis of different types of tumors. Genotyping was performed by PCR‐RFLP (polymerase chain reaction followed by restriction fragment length polymorphism) using a restriction enzyme HpaII cleavage. No significant difference was observed in genotype distribution between breast cancer patients (GG: 57.3%; GA: 39.8%; AA: 2.9%) and healthy female controls (GG: 62.9%; GA: 33%; AA: 4.1%) nor between HL patients (GG: 61.1%; GA:27.8%; AA: 11.1%) and healthy controls (GG: 65.6%; GA: 28.9%; AA: 5.5%), whereas a significant difference was observed in genotype distribution between NHL patients (GG: 51.4%; GA: 47.1%; AA: 1.5%) and healthy controls (GG: 65.6%; GA: 28.9%; AA: 5.5%). Further studies will be necessary to elucidate the cancer chemokine network. However, this study suggests that CXCL12 rs1801157 polymorphism may have important implications in the pathogenesis of NHL. J. Clin. Lab. Anal. 23:387–393, 2009.

Effect of Long-term Fortification of Whey Drink With Ferrous Bisglycinate on Anemia Prevalence in Children and Adolescents From Deprived Areas in Londrina, Paraná, Brazil☆

OBJECTIVE Fortification of food with iron is considered the best sustainable way of preventing iron deficiency when an appropriate diet is not available. The most difficult challenge is to find the ideal combination of iron fortification compound and food vehicle. We investigated the effect of cheese whey drink with 15% of frozen strawberry fortified with ferrous bisglycinate on hemoglobin values in children and adolescents. METHODS The assessed population participates in Public Educational Centers in Londrina, Paraná (southern Brazil), which assist families living in precarious socioeconomic conditions (annual income < 500.00 US dollars per capita). Hemoglobin was measured for 1 y with a Hemocue portable photometer. Anemia was defined as hemoglobin values below 12 g/dL. Thus, hemoglobin was verified in 467 (7 to 14 y) individuals (249 boys and 218 girls). RESULTS Although anemia prevalence did not decrease after 3 mo, there was a statistically significant decrease from 41.9% at the beginning of the study to 26.4% after 6 mo (P < 0.001) and to 9.6% after 1 y (P < 0.001). Statistically significant changes (mean +/- standard deviation) were observed between children and adolescents with hemoglobin values below 11 g/dL (increase of 2.2 +/- 1.03) and above 12 g/dL (increase of 0.35 +/- 1.07; P < 0.0001). CONCLUSION There was a marked reduction in the prevalence of anemia in children and adolescents after long-term fortification of whey drink with ferrous bisglycinate.