Real-time monitoring of progression towards renal failure in primary care patients

First published online: December 16, 2014.

A aula de orquestra como laboratório para a criatividade

Relatório de estágio de mestrado em Ensino da Música

Assessment of the techniques of blood pressure measurement by health professionals

OBJECTIVE: To assess blood pressure measurement by health professionals of a public hospital in São Paulo State. METHODS: Semi-structured interviews and direct observation were performed with a verification list according to the criteria reported by Perloff et al. One hundred and five health professionals took part in the study. After measuring blood pressure, the level of concordance between the way the procedure was performed and the recommended one was assessed. RESULTS: Nurses and nurse's aides abided by 40% of the recommended procedures for adequate blood pressure measurement. The other categories of health professionals (nursing and medicine teachers, physicians, residents, and nursing students) abided by approximately 70%. CONCLUSION: Permanent educational activities aiming at standardizing blood pressure measurement should be implemented among the different categories of health professionals.

Protein content and electrophoretic profile of fat body and ovary extracts from workers of Melipona quadrifasciata anthidioides (Hymenoptera, Meliponini)

Workers of Melipona quadrifasciata anthidioides (Lepeletier, 1836) develop their ovaries and lay eggs, therefore the production of vitellogenin is expected. In electrophoretic profiles only fat body extracts from nurse workers and ovary extracts from newly-emerged workers show protein with molecular mass similar to vitellogenin. However, an increase in the protein content was detected in forager fat body. This increase was attributed to storage of vitellogenin or other proteins in the previous phase and not discharged into the hemolymph or to an effect of the increased titre of juvenile hormone in this phase of worker life over the fat body functioning.

Morphological aspects of cell reabsorption in laying queens and workers of Apis mellifera (Hymenoptera, Apidae)

The occurrence of cell reabsorption in the ovaries of queens in several rates of laying eggs, artificially impeded of laying, and in nurse workers, of Apis mellifera (Linnaeus, 1758), was studied with light (LM) and transmission electron microscopy (TEM). Two types of structures were described and named by analogy with vertebrates ovarian structures, as corpus luteus, when resulting from the reabsorption of the follicular cells after ovulation, and corpus atresicus when resulting from total follicular reabsorption at any oocyte developmental stage. These structures have the same morphological characteristics and physiological signification in both castes. The corpus luteus occurrence indicates ovulation and its number is correspondent to the queen's rates of oviposition. The presence of this structure in nurse workers ovarioles shows that this caste may lay eggs. The incidence of corpus atresicus in queens decay with the increasing of the oviposition indicating that the inhibition of the normal sequence of oocyte maturation in the ovaries is deleterious. Both, corpus luteus and corpus atresicus incidence may be influenced by environmental factors.

Trophic ecology and the use of shelters and latrines by the Neotropical otter (Lontra longicaudis) in the Taquari Valley, Southern Brazil

This manuscript presents information about the ecology of Lontra longicaudis (Olfers, 1818) in the Taquari Valley, State of Rio Grande do Sul, southern Brazil. The study was carried out in two areas located in the Forquetinha Creek and in the Forqueta River from January to December 2003. The otters are specialist feeders (Bsta = 0.24), with a diet based mostly on fish, especially those of the families Loricariidae and Cichlidae. Most shelters used by the species were excavated burrows underneath tree roots, while shelters within rocks were used less frequently. The burrows showed great variation in size, being found on average 3.5 m (sd = 3.6 m) away from the margin and 2.5 m (sd = 1.2 m) above the water level. Scent marks were made preferentially on rocks and fallen tree trunks at the edge of the water. There was a tendency to increase the reutilization of latrines in detriment of using new sites throughout the sample period.

Community structure of metazoan parasites of silverside, Odontesthes bonariensis (Pisces, Atherinopsidae) from Argentina

The helminth communities of silverside, Odontesthes bonariensis (Valenciennes, 1835), from two Argentinean lagoons were studied and compared at component community and infracommunity levels. Nine helminth species were found: five digeneans (Austrodiplostomum cf. mordax, Ascocotyle (Phagicola) cf. diminuta, Ascocotyle sp., Thometrema bonariensis and Saccocoelioides sp.); two nematodes (Contracaecum sp. and Hysterothylacium sp.); one acanthocephalan (Wolffhugelia matercula) and one cestode (Cangatiella macdonaghi). Odontesthes bonariensis is a new host record for five parasite species. Richness, diversity and number of helminths in silversides from Salada Grande lagoon were higher than in those from Lacombe lagoon. This could be related with lagoon size, abundance of mollusks and fish-eating birds, and size and diet of silversides captured in each lagoon. In Salada Grande lagoon the helminth community of silversides was dominated by the allogenic and generalist species A. cf. mordax; while the autogenic and intermediate specialist species C. macdonaghi was dominant in Lacombe lagoon. Host sex did not affect richness, diversity or total abundance, whereas host size was positively correlated with these attributes, except diversity in Salada Grande lagoon.

Bird community in an Araucaria forest fragment in relation to changes in the surrounding landscape in Southern Brazil

The dynamics of the bird community in a small forest fragment was evaluated along seven years in relation to changes in the surrounding landscape. The study area is an Araucaria forest fragment in Southern Brazil (state of Paraná). The sampling period covered the years 1988 through 1994 and the mark-release-recapture method was utilized. The landscape analysis was based on Landsat TM images, and changes in exotic tree plantations, native forest, open areas (agriculture, pasture, bare soil, and abandoned field), and "capoeira"(native vegetation < 2 m) were quantified. The relationship between landscape changes and changes in abundance diversity of forest birds, open-area birds, forest-edge birds, and bamboo specialists was evaluated. Richness estimates were run for each year studied. The richness recorded in the study area comprised 96 species. The richness estimates were 114, 118 and 110 species for Chao 1, Jackknife 1 and Bootstrap, respectively. The bird community varied in species richness, abundance and diversity from year to year. As for species diversity, 1991, 1993 and 1994 were significantly different from the other years. Changes in the landscape contributed to the increase in abundance and richness for the groups of forest, open-area and bamboo-specialist species. An important factor discussed was the effect of the flowering of "taquara" (Poaceae), which contributed significantly to increasing richness of bamboo seed eaters, mainly in 1992 and 1993. In general, the results showed that landscape changes affected the dynamics and structure of the bird community of this forest fragment over time, and proved to have an important role in conservation of the avian community in areas of intensive forestry and agricultural activities.

Diet of Procyon cancrivorus (Carnivora, Procyonidae) in restinga and estuarine environments of southern Brazil

Despite its wide range and abundance on certain habitats, the crab-eating raccoon Procyon cancrivorus (G. Cuvier, 1798) is considered one of the less known Neotropical carnivore species. In the present study we analyzed the diet of P. cancrivorus in a peat forest and in an estuarine island in southernmost Brazil. Fruits of the gerivá palm tree Syagrus romanzoffiana were the most consumed item in the peat forest, followed by insects and mollusks. Small mammals, followed by Bromelia antiacantha (Bromeliaceae) fruits and brachyuran crustaceans were the most frequent items in the estuarine island. Other items found in lower frequencies were Solanum sp., Psidium sp., Smilax sp. and Dyospiros sp. fruits, diplopods, scorpions, fishes, anuran amphibians, reptiles (black tegu lizard and snakes), birds and medium-sized mammals (white-eared opossum, armadillo and coypu). Levin’s index values (peat forest: 0.38; estuarine island: 0.45) indicate an approximation to a median position between a specialist and a well distributed diet. Pianka’s index (0.80) showed a considerable diet similarity between the two systems. Procyon cancrivorus presented a varied diet in the studied areas and may play an important role as seed disperser on coastal environments in southernmost Brazil.

Endocardites sépticas: (contribuição etiopatogênica)

In the present paper the A. A. reviewed the more fundamental problems in the ethiopathogenic process of bacterial endocardits and report the bacte¬riological observations done by them in 20 cases of the disecase observed at the Section of Pathological Anatomy and Bacteriology of the Hospital S. Francisco de Assis in charge of the Instituto Oswaldo Cruz. The A.A. isolated Pneumococcus from 10 out the 20 cases, Gonococcus from 2, Staphylococcus from 2, Streptococcus from 5 and Friedlaender bacil¬lus from 1 . The A.A. mainly lay stress on the necessity of the bacteriological exa¬minations being made by a specialist, owing to the difficulties sometimes met with and to the consequences of a detailed examination of the isolated germ.

Promoting hospital-based smoking cessation services at major Swiss hospitals: a before and after study.

Whether a 1-year nationwide, government supported programme is effective in significantly increasing the number of smoking cessation clinics at major Swiss hospitals as well as providing basic training for the staff running them. We conducted a baseline evaluation of hospital services for smoking cessation, hypertension, and obesity by web search and telephone contact followed by personal visits between October 2005 and January 2006 of 44 major public hospitals in the 26 cantons of Switzerland; we compared the number of active smoking cessation services and trained personnel between baseline to 1 year after starting the programme including a training workshop for doctors and nurses from all hospitals as well as two further follow-up visits. At base line 9 (21%) hospitals had active smoking cessation services, whereas 43 (98%) and 42 (96%) offered medical services for hypertension and obesity respectively. Hospital directors and heads of Internal Medicine of 43 hospitals were interested in offering some form of help to smokers provided they received outside support, primarily funding to get started or to continue. At two identical workshops, 100 health professionals (27 in Lausanne, 73 in Zurich) were trained for one day. After the programme, 22 (50%) hospitals had an active smoking cessation service staffed with at least 1 trained doctor and 1 nurse. A one-year, government-supported national intervention resulted in a substantial increase in the number of hospitals allocating trained staff and offering smoking cessation services to smokers. Compared to the offer for hypertension and obesity this offer is still insufficient.

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Primary ciliary dyskinesia (PCD) is an autosomal recessive disease with an incidence estimated between 1:2,000 and 1:40,000. Ciliated epithelia line the airways, nasal and sinus cavities, Eustachian tube and fallopian tubes. Congenital abnormalities of ciliary structure and function impair mucociliary clearance. As a consequence, patients present with chronic sinopulmonary infections, recurrent glue ear and female subfertility. Similarities in the ultrastructure of respiratory cilia, nodal cilia and sperm result in patients with PCD also presenting with male infertility, abnormalities of left-right asymmetry (most commonly situs inversus totalis) and congenital heart disease. Early diagnosis is essential to ensure specialist management of the respiratory and otological complications of PCD. Diagnostic tests focus on analysis of ciliary function and electron microscopy structure. Analysis is technically difficult and labour intensive. It requires expertise for interpretation, restricting diagnosis to specialist centres. Management is currently based on the consensus of experts, and there is a pressing need for randomised clinical trials to inform treatment.

Five-year evolution of drug prescribing in a university adult intensive care unit

Introduction: Drug prescription is difficult in ICUs as prescribers are many, drugs expensive and decisions complex. In our ICU, specialist clinicians (SC) are entitled to prescribe a list of specific drugs, negotiated with intensive care physicians (ICP). The objective of this investigation was to assess the 5-year evolution of quantity and costs of drug prescription in our adult ICU and identify the relative costs generated by ICP or SC. Methods: Quantities and costs of drugs delivered on a quarterly basis to the adult ICU of our hospital between 2004 and 2008 were extracted from the pharmacy database by ATC code, an international five-level classification system. Within each ATC first level, drugs with either high level of consumption, high costs or large variations in quantities and costs were singled out and split by type of prescriber, ICP or SC. Cost figures used were drug purchase prices by the hospital pharmacy. Results: Over the 5-year period, both quantities and costs of drugs increased, following a nonsteady, nonparallel pattern. Four ATC codes accounted for 80% of both quantities and costs, with ATC code B (blood and haematopoietic organs) amounting to 63% in quantities and 41% in costs, followed by ATC code J (systemic anti-infective, 20% of the costs), ATC code N (nervous system, 11% of the costs) and ATC code C (cardiovascular system, 8% of the costs). Prescription by SC amounted to 1% in drug quantities, but 19% in drug costs. The rate of increase in quantities and costs was seven times larger for ICP than for SC (Figure 1 overleaf ). Some peak values in costs and quantities were related to a very limited number of patients. Conclusions: A 5-year increase in quantities and costs of drug prescription in an ICU is a matter of concern. Rather unexpectedly, total costs and cost increases were generated mainly by ICP. A careful follow-up is necessary to try influencing this evolution through an institutional policy co-opted by all professional categories involved in the process.

Comparison of two osteoporotic fracture management pathways: experience at 1 year

Introduction: Osteoporosis presenting as low-impact fractures to traumatology units is often undiagnosed and under-treated. Results from the Osteocare study in Lausanne (a nurse based intervention, passive pathway) showed that only 19% of patients received management for osteoporosis, and in the literature [1], the rate is between 10-25%. We have evaluated a different management concept, based on the systematic assessment of patients with osteoporotic fractures during and after hospitalization (active pathway). Methods: Inpatients admitted to the Department of Musculoskeletal Medicine for a fragility fracture were identified by a nurse according to a predefined questionnaire and were then clinically evaluated by a doctor. Based on the results, a management plan was proposed to the patients. Patients could choose between follow up either by their GP or by the Centre of Bone Disease of the CHUV. For patients who chose follow-up in our Centre, we assessed their adherence to medical follow-up 1 year inclusion. The results of patients who had been evaluated in our cohort between the 1 November 2008 and the 1 December 2009 were analysed. Results: 573 inpatients received specific management of their osteoporotic fracture over 18 months. The mean age was 77 y (31-99), 81% were women (203 hip fractures, 40 pelvis fractures, 101 arm fractures, 57 vertebral fractures, 63 ankle fractures, and 25 others sites). During the study period, 303 patients received a proposition of a specific treatment. 39 (13%) chose a follow up with the GP, 19 (6%) dead and 245 (81%) preferred a follow up in our Centre. After 1 year, 166 (67%) patients are under follow up in our outpatient clinic. Conclusion: With an active clinical pathway that starts during the hospitalization, consisting on a nursing evaluation followed by a medical consultation by an expert in osteoporosis, the adherence increased from 19% to 67% in terms of follow up. These results lead us to propose a consultation with a doctor experienced in osteoporosis after all osteoporotic fractures.

Chronic beryllium disease as a re-emerging occupational disorder possibly misdiagnosed as sarcoidosis : a Swiss study project

Background: Beryllium (Be) is increasingly used worldwide for numerous industrial applications. Occupational exposure to Be may lead to Be sensitization (BeS), a CD4-mediated immune response. BeS may progress to chronic beryllium disease (CBD), a granulomatous lung disorder closely resembling sarcoidosis. The recognition of CBD requires detection of Be exposure at occupational history, and detection of BeS on blood or BAL lymphocytes. Since methods for CBD detection are not routinely available in Switzerland, we hypothesized that CBD cases are not recognized but misdiagnosis as sarcoidosis. Objective: To present an ongoing Swiss study screening patients with sarcoidosis in search of Be exposure, BeS, and CBD. Methods: Both a prospective and a retrospective cohort are being studied. In the prospective cohort, the main steps include: 1) recruitment of 100 consecutive patients with newly diagnosed pulmonary sarcoidosis at 2 centers (Lausanne, Bern). 2) screening for possible occupational Be exposure by self-administered patient questionnaire. 3) standardized detailed occupational interview and clinical visit by occupational health specialist. If step 3 is positive, then 4) blood and BAL sampling for detection of BeS by specifically developed Elispot assay and CFSE flow cytometry, with subsequent comparison to the classical Be lymphocyte proliferation test. If step 4 is positive, then 5) review of medical records and diagnostic revision from sarcoidosis to CBD. 6) appropriate measures for exposure cessation and case reporting to SUVA as occupational disease. The retrospective cohort will include 400 patients with previously diagnosed pulmonary sarcoidosis, either treated or untreated, recruited through the SIOLD Registries. Steps 2 to 5 will be peformed as above, except for a) end of study after step 2 if screening questionnaire does not reveal Be exposure, and b) step 4 done on blood sample only (BAL not needed). Current status: Self-administered screening questionnaire and tools for standardized occupational interview have been developed. BeS testing has been implemented and undergoes validation. Inclusions in the prospective phase have started at both study sites. The retrospective phase is in preparation. Conclusion: The current study status allows to conclude to technical feasibility of the project. The prospective phase if this study is funded by the SUVA. The SIOLD Registries are supported by the Swiss Pulmonary League.