Impact of hyperglycemia on morbidity and mortality, length of hospitalization and rates of re-hospitalization in a general hospital setting in Brazil

<p>Abstract</p> <p>Background</p> <p>Hyperglycemia in hospitalized patients is known to be related to a higher incidence of clinical and surgical complications and poorer outcomes. Adequate glycemic control and earlier diagnosis of type 2 diabetes during hospitalization are cost-effective measures.</p> <p>Methods</p> <p>This prospective cohort study was designed to determine the impact of hyperglycemia on morbidity and mortality in a general hospital setting during a 3-month period by reviewing patients' records. The primary purposes of this trial were to verify that hyperglycemia was diagnosed properly and sufficiently early and that it was managed during the hospital stay; we also aimed to evaluate the relationship between in-hospital hyperglycemia control and outcomes such as complications during the hospital stay, extent of hospitalization, frequency of re-hospitalization, death rates and number of days in the ICU (Intensive Care Unit) after admission. Statistical analyses utilized the Kruskall-Wallis complemented by the "a posteriori" d.m.s. test, Spearman correlation and Chi-squared test, with a level of significance of 5% (p < 0.05).</p> <p>Results</p> <p>We reviewed 779 patient records that fulfilled inclusion criteria. The patients were divided into 5 groups: group (1) diabetic with normal glycemic levels according to American Diabetes Association criteria for in-hospital patients (n = 123); group (2) diabetics with hyperglycemia (n = 76); group (3) non-diabetics with hyperglycemia (n = 225); group (4)diabetics and non-diabetics with persistent hyperglycemia during 3 consecutive days (n = 57) and group (5) those with normal glucose control (n = 298). Compared to patients in groups 1 and 5, patients in groups 2, 3 and 4 had significantly higher mortality rates (17.7% vs. 2.8%) and Intensive Care Unit admissions with complications (23.3% vs. 4.5%). Patients in group 4 had the longest hospitalizations (mean 15.5 days), and group 5 had the lowest re-hospitalization rate (mean of 1.28 hospitalizations). Only 184 (51.4%) hyperglycemic patients had received treatment. An insulin "sliding-scale" alone was the most frequent treatment used, and there was a wide variation in glucose target medical prescriptions. Intra Venous insulin infusion was used in 3.8% of patients in the ICU. Glycohemoglobin(A1C) was measured in 11 patients(2.2%).</p> <p>Conclusions</p> <p>Hospital hyperglycemia was correlated with, among other parameters, morbidity/mortality, length of hospitalization and number of re-hospitalizations. Most patients did not have their glycemic levels measured at the hospital; despite the high number of hyperglycemic patients not diagnosed as diabetics, A1C was not frequently measured. Even when patients are assessed for hyperglycemia, they were not treated properly.</p

Metais presentes no chorume coletado no aterro sanitário de Ribeirão Preto, São Paulo, Brasil, e sua relevância para saúde pública Metals in landfill leachate in Ribeirão Preto, São Paulo State, Brazil, and its relevance for public health

O presente estudo teve como objetivo a avaliação dos níveis de cádmio, chumbo, cobre, cromo, manganês, mercúrio e zinco, no chorume gerado no aterro sanitário de Ribeirão Preto, São Paulo, Brasil. Amostras do líquido foram coletadas nos tanques de captação do módulo I (funcionou de 1989 até outubro do ano de 2000) e do módulo II (vem funcionando desde novembro do ano de 2000), sendo analisadas por Espectrofotometria de Absorção Atômica no setor de metais do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Os resultados foram comparados com os valores máximos permitidos para concentração de metais em efluentes líquidos presentes na Resolução nº. 357/2005 do Conselho Nacional do Meio Ambiente. Foi verificado, também, se existe atenuação na concentração de metais no chorume, considerando a diferença no tempo de vida dos módulos do aterro sanitário em análise. Os resultados deste estudo mostraram que os valores médios de cádmio, cromo, cobre, manganês e mercúrio encontram-se dentro dos limites máximos permitidos, no entanto os valores médios de chumbo e zinco apresentam-se acima dos limites especificados pela referida resolução.<br>This study analyzed the levels of cadmium, lead, copper, chromium, manganese, mercury, and zinc in leachate from the Ribeirão Preto landfill site in São Paulo State, Brazil. Samples were taken from runoff tanks in Module I (operating from 1989 to 2000) and Module II (operating since November 2000). Metal levels were measured by atomic absorption spectrophotometry at the University of São Paulo in Ribeirão Preto (University Hospital). Results were compared to the maximum limits for metal concentration in liquid effluents set by Ruling 357/2005 of the National Environmental Council (CONAMA). The study also investigated whether there was any attenuation in metal concentrations in the leachate, considering differences in the life spans of the various Ribeirão Preto landfill site modules. Metal levels in the samples were within the maximum limits for cadmium, chromium, copper, mercury, and manganese, but lead and zinc were above the limits set by the above-mentioned ruling

Efeitos do alcoolismo e da desintoxicação alcoólica sobre o reparo e biomecânica óssea Effects of alcoholism and alcoholic detoxication on the repair and biomechanics of bone

OBJETIVO: Avaliar os efeitos do consumo crônico de etanol e da desintoxicação alcoólica sobre a resistência mecânica do osso e neoformação óssea junto a implantes de hidroxiapatita densa (HAD) realizados em ratos. MÉTODOS: Foram utilizados 15 ratos divididos em três grupos, sendo controle (CT), alcoolista crônico (AC) e desintoxicado (DE). Após quatro semanas, foi realizada implantação de HAD na tíbia e produzida falha no osso parietal, em seguida o grupo AC continuaram a consumir etanol e o grupo DE iniciaram a desintoxicação. Ao completar 13 semanas os animais sofreram eutanásia, os ossos foram coletados para o processamento histomorfométrico e os fêmures encaminhados ao teste mecânico de resistência. RESULTADOS: Os animais do grupo AC apresentaram menores valores de neoformação óssea, de calcemia e resistência mecânica, quando comparado aos grupos CT e DE. Os animais dos grupos DE apresentaram valores superiores em todas as variáveis avaliadas em relação ao grupo AC. CONCLUSÃO: O consumo de etanol interferiu na osteogênese ao redor de implante de HAD, nos níveis de cálcio e na resistência mecânica óssea. A desintoxicação alcoólica se mostrou eficaz, pois aumentou à osteogênese e osseointegração da HAD, a calcemia e resistência mecânica óssea. Nivel de Evidência I, estudo terapeutico.<br>OBJECTIVE: To evaluate the effects of chronic ethanol consumption and alcohol detoxication on the mechanical resistance of bone and bone neoformation around dense hydroxyapatite implants (DHA) in rats. METHODS: Fifteen rats were separated into three groups: (1) control group (CT); (2) chronic alcoholic (CA), and (3) disintoxicated (DI). After four weeks, a DHA was implanted in the right tibia of the animals, and the CA group continued consuming ethanol, while the DI group started detoxication. The solid and liquid feeding of the animals was recorded, and a new alcohol dilution was effected every 48 hours. After 13 weeks, the animals were euthanized and their biological material was collected. RESULTS: Bone tissue was found around DHA in all the animals. Group CA showed less bone neoformation, lower levels of ionic and total calcium when compared to the animals of the CT and DI groups. The DI animals showed higher values in all the variables in relation to the CA group. CONCLUSION: Ethanol consumption interfered in osteogenesis around the DHA implants, and in calcium levels and mechanical bone resistance. Alcohol detoxication was effective, as it increased osteogenesis, DHA osteointegration, calcemia, and mechanical resistance of the bone. Level of Evidence: Level I, therapeutic studie