Possible adverse drug events leading to hospital admission in a Brazilian teaching hospital

OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to December 2008. All patients aged ≥18 years with a length of stay ≥24 hours were interviewed about the drugs used prior to hospital admission and their symptoms/complaints/causes of hospitalization. RESULTS: In total, 248 patients were considered eligible. The prevalence of hospitalization due to potential adverse drug events in the ward was 46.4%. Overprescribed drugs and those indicated for prophylactic treatments were frequently associated with possible adverse drug events. Frequently reported symptoms were breathlessness (15.2%), fatigue (12.3%), and chest pain (9.0%). Polypharmacy was a risk factor for the occurrence of possible adverse drug events. CONCLUSION: Possible adverse drug events led to hospitalization in a high-complexity hospital, mainly in polymedicated patients. The clinical outcomes of adverse drug events are nonspecific, which delays treatment, hinders causality analysis, and contributes to the underreporting of cases.

Análise dos atendimentos do SAMU 192: componente móvel da Rede de Atenção às Urgências e Emergências

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Determinantes genéticos, bioquímicos e clínicos na resposta ao uso de hidroxiureia na doença falciforme

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Interactions of age and leg muscle fatigue on unobstructed walking and obstacle crossing

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

BackgroundThis is an update of a Cochrane Review first published in The Cochrane Library 2008, Issue 3.Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry compared to no therapy or physiotherapy, including coughing and deep breathing, on all-cause postoperative pulmonary complications andmortality in adult patients admitted to hospital for upper abdominal surgery.ObjectivesOur primary objective was to assess the effect of incentive spirometry (IS), compared to no such therapy or other therapy, on postoperative pulmonary complications and mortality in adults undergoing upper abdominal surgery.Our secondary objectives were to evaluate the effects of IS, compared to no therapy or other therapy, on other postoperative complications, adverse events, and spirometric parameters.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE, EMBASE, and LILACS (from inception to August 2013). There were no language restrictions. The date of the most recent search was 12 August 2013. The original search was performed in June 2006.Selection criteriaWe included randomized controlled trials (RCTs) of IS in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.Data collection and analysisTwo authors independently assessed trial quality and extracted data.Main resultsWe included 12 studies with a total of 1834 participants in this updated review. The methodological quality of the included studies was difficult to assess as it was poorly reported, so the predominant classification of bias was 'unclear'; the studies did not report on compliance with the prescribed therapy. We were able to include data from only 1160 patients in the meta-analysis. Four trials (152 patients) compared the effects of IS with no respiratory treatment. We found no statistically significant difference between the participants receiving IS and those who had no respiratory treatment for clinical complications (relative risk (RR) 0.59, 95% confidence interval (CI) 0.30 to 1.18). Two trials (194 patients) IS compared incentive spirometry with deep breathing exercises (DBE). We found no statistically significant differences between the participants receiving IS and those receiving DBE in the meta-analysis for respiratory failure (RR 0.67, 95% CI 0.04 to 10.50). Two trials (946 patients) compared IS with other chest physiotherapy. We found no statistically significant differences between the participants receiving IS compared to those receiving physiotherapy in the risk of developing a pulmonary condition or the type of complication. There was no evidence that IS is effective in the prevention of pulmonary complications.Authors' conclusionsThere is low quality evidence regarding the lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large RCTs with high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.

Proposal to utilize simplified Swensen protocol in diagnosis of isolated pulmonary nodule

Background: The problem of diagnosing whether a solitary pulmonary nodule is benign or malignant is even greater in developing countries due to a higher prevalence of infectious diseases. These infections generate a large number of patients who are generally asymptomatic and with a pulmonary nodule that cannot be accurately defined as having benign or malignant etiology.Purpose: To verify the percentages of benign versus malignant non-calcified nodules, the length of time after contrast agent injection is spiral computed tomography (CT) most sensitive and specific, and whether three postcontrast phases are necessary.Material and Methods: We studied 23 patients with solitary pulmonary nodules identified on chest radiographs or CT. Spiral scans were obtained with Swensen protocol, but at 3, 4, and 5 min after contrast injection onset. Nodules were classified as benign or malignant by histopathological examination or by an absence or presence of growth after 2 years of follow-up CT.Results: Of the 23 patients studied, 18 (78.2%) showed a final diagnosis of benign and five (21.7%) malignant nodules. Despite the small sample size, we obtained results similar to those of Swensen et al., with 80.0% sensitivity, 55.5% specificity, and 60.8% accuracy. Four minutes gave the greatest mean enhancement in both malignant and benign lesions.Conclusion: Small non-calcified benign nodules were much more frequent than malignant nodules. The best time for dynamic contrast-enhanced CT density analysis was 4 min postcontrast. As well as saving time and money, this simplified Swensen protocol with only precontrast and 4 min postcontrast phases also reduces patient exposure to ionizing radiation.

Three-Dimensional Sonographic Assessment of Placental Volume and Vascularization in Pregnancies Complicated by Hypertensive Disorders

Objectives-The purpose of this study was to evaluate the association between placental volumes, placental vascularity, and hypertensive disorders in pregnancy.Methods A prospective case-control study was conducted between April 2011 and July 2012. Placental volumes and vascularity were evaluated by 3-dimensional sonographic, 3-dimensional power Doppler histographic, and 2-dimensional color Doppler studies. Pregnant women were classified as normotensive or hypertensive and stratified by the nature of their hypertensive disorders. The following variables were evaluated: observed-to-expected placental volume ratio, placental volume-to-estimated fetal weight ratio, placental vascular indices, and pulsatility indices of the right and left uterine and umbilical arteries.Results Sixty-six healthy pregnant women and 62 pregnant women with hypertensive disorders were evaluated (matched by maternal age, gestational age at sonography, and parity). Placental volumes were not reduced in pregnancy in women with hypertensive disorders (P > .05). Conversely, reduced placental vascularization indices (vascularization index and vascularization-flow index) were observed in pregnancies complicated by hypertensive disorders (P < .01; P < .01), especially in patients with superimposed preeclampsia (P = .04; P = .02). A weak correlation was observed between placental volumes, placental vascular indices, and Doppler studies of the uterine and umbilical arteries.Conclusions Pregnancies complicated by hypertensive disorders are associated with reduced placental vascularity but not with reduced placental volumes. These findings are independent of changes in uterine artery Doppler studies. Future studies of the prediction of preeclampsia may focus on placental vascularity in combination with results of Doppler studies of the uterine arteries.

Correlations between ovarian follicular blood flow and superovulatory responses in ewes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Desempenho de novilhos Nelore confinados alimentados com óleo de linhaça in natura ou protegido

Pós-graduação em Zootecnia - FCAV

A new tuning fork with different vibration frequencies as an aid to bronchopulmonary hygiene physiotherapy

Background: The main function of the mucociliary system is the removal of particles or substances that are potentially harmful to the respiratory tract. The tuning fork therapeutic for the purpose of bronchial hygiene has still not been described in the literature. The optimal vibration frequency to mobilize secretions is widely debated and varies between 3 and 25 Hz. It is expected that a tuning fork is able to generate vibrations in the thorax, facilitating bronchial hygiene. The aim of the present study is to develop tuning forks with different frequencies, for use in bronchopulmonary hygiene therapy. Methods: The first tuning fork was made with a fixed frequency of 25 Hz and it was recorded in the Brazilian institution of patent registration. This device generated a frequency of 25 Hz and had a weight of 521 g, with dimensions of 600 mm in total length. The device is characterized by a bottom end containing a transducer with a diameter of 62 mm and a thickness of 5/16 mm (8''), a rod removable 148 mm, fork length of 362 mm and an extension at the upper end of sinuous shape bilaterally.The tuning forks must be applied at an angle of 90° directly on the chest wall of the patient after pulmonary auscultation for location of secretions. The tuning fork is activated by squeezing the tips of the extensions together and releasing them in a sudden movement. Results: This study shows the result of the development of others three tuning forks of different dimensions to generate different frequencies. Each equipment reaches a fixed frequency preset of 12, 15 and 20 Hz measured by digital oscilloscope. Conclusions: The tuning fork models developed in this study generated different frequencies proposed by the scientific literature as effective in the mobilization of pulmonary secretions.

Identificação de regiões genômicas selecionadas de forma divergente em equinos quarto de milha de corrida e trabalho

Pós-graduação em Genética e Melhoramento Animal - FCAV

Influência da imunocastração (Bopriva®) no ganho de peso, características de carcaça e qualidade da carne de bovinos Nelore

The objective of this study was evaluate the effects of immunocastration on body weight gain, carcass characteristics and meat quality of Nellore beef cattle. Eighty Nellore beef cattle, with initial body weight of 357 +/- 8.63 kg, were placed in feedlots and distributed in two treatments (40 animals per treatments) as follow: one - non-vaccinated bulls and two - immunocastrated bulls (Bopriva (R), Pfizer Animal Health). The animals placed on treatment two were vaccinated in two doses, first application 30 days before they arrive on the feedlots and second on the day they arrive on feedlots. After 67 days of experimental period, was calculated the daily gain of live weight in kg/day of the 80 animals and selected 20 animals from each treatment for the slaughter and carcass evaluations, and ten from each group for the meat analyzes. The data were submitted to analysis of variance. Immunocastrated animals showed lower daily weight gain, hot carcass weight, carcass yield, pH, leg thickness, muscle depth, loin muscle area, carcass muscle percentage, shear force and moisture. However, this animals had higher concentration of lactate and cortisol blood, chest depth, fat thickness, finishing degree, a *, b * and c*, liquid loss in thawing process, myofibrillar fragmentation index and ether extract of meat when compared to non-vaccinated bulss. The immunocastration (Bopriva (R)) is an alternative for improving the quality of meat by the higher fat deposition and by the reduction of the shear force of the meat when compared to non-vaccinated bulls.