Fatores de atraso na alta hospitalar em hospitais de ensino

OBJECTIVE To analyze the causes of delay in hospital discharge of patients admitted to internal medicine wards. METHODS We reviewed 395 medical records of consecutive patients admitted to internal medicine wards of two public teaching hospitals: Hospital das Clínicas of the Universidade Federal de Minas Gerais and Hospital Odilon Behrens. The Appropriateness Evaluation Protocol was used to define the moment at which notes in the medical records indicated hospital stay was no longer appropriate and patients could be discharged. The interval between this estimated time and actual discharge was defined as the total number of days of delay in hospital discharge. An instrument was used to systematically categorize reasons for delay in hospital discharge and frequencies were analyzed. RESULTS Delays in discharge occurred in 60.0% of 207 hospital admissions in the Hospital das Clínicas and in 58.0% of 188 hospital admissions in the Hospital Odilon Behrens. Mean delay per patient was 4.5 days in the former and 4.1 days in the latter, corresponding to 23.0% and 28.0% of occupancy rates in each hospital, respectively. The main reasons for delay in the two hospitals were, respectively, waiting for complementary tests (30.6% versus 34.7%) or for results of performed tests to be released (22.4% versus 11.9%) and medical-related accountability (36.2% versus 26.1%) which comprised delays in discussing the clinical case and in clinical decision making and difficulties in providing specialized consultation (20.4% versus 9.1%). CONCLUSIONS Both hospitals showed a high percentage of delay in hospital discharge. The delays were mainly related to processes that could be improved by interventions by care teams and managers. The impact on mean length of stay and hospital occupancy rates was significant and troubling in a scenario of relative shortage of beds and long waiting lists for hospital admission.OBJETIVO Analisar os motivos de atraso na alta hospitalar de pacientes internados em enfermarias de clínica médica. MÉTODOS Foram analisados 395 prontuários de pacientes consecutivos das enfermarias de clínica médica de dois hospitais públicos de ensino: Hospital das Clínicas da Universidade Federal de Minas Gerais e Hospital Odilon Behrens. Foi utilizado o Appropriateness Evaluation Protocol para definir o momento a partir do qual as anotações do prontuário permitiam concluir que a permanência no hospital não mais era adequada. O intervalo entre esse momento e a data da alta hospitalar efetivada definiu o total de dias de atraso na alta hospitalar. Foi utilizado, sistematicamente, instrumento para categorizar os motivos de atraso da alta hospitalar, tendo sido realizada análise de frequências. RESULTADOS O atraso na alta hospitalar ocorreu em 60,0% das 207 internações do Hospital das Clínicas e em 58,0% das 188 internações do Hospital Odilon Behrens. O atraso por paciente foi em média de 4,5 dias no primeiro e 4,1 dias no segundo, o que corresponde à taxa de ocupação de 23,0% e 28,0% em cada hospital, respectivamente. Os principais motivos de atraso nos dois hospitais foram, respectivamente: espera para realização de exames complementares (30,6% e 34,7%) ou para liberação dos laudos dos exames (22,4% e 11,9%) e os relacionados à responsabilidade médica (36,2% e 26,1%), compreendendo a demora na discussão do caso clínico e na tomada de decisão clínica e dificuldades nas interconsultas, respectivamente (20,4% e 9,1%). CONCLUSÕES Foi constatado percentual elevado de atraso na alta hospitalar nos dois hospitais. O atraso foi devido principalmente a fatores relacionados a processos, que podem ser melhorados por intervenções da equipe assistencial e dos gestores. O impacto na média de permanência hospitalar e na taxa de ocupação foi expressivo e preocupante, num cenário de relativa escassez de leitos e longas esperas por internação

Effect of green tea extract on bonding durability of an etch-and-rinse adhesive system to caries-affected dentin

Objective Green tea extract has been advocated as a matrix metalloproteinase (MMP) inhibitor; however, its effect on bond durability to caries-affected dentin has never been reported. Thus, the aim of this in vitro study was to evaluate the effect of two MMP inhibitors (2% chlorhexidine and 2% green tea extract), applied after acid etching, on bond durability of an etch-and-rinse adhesive system to caries-affected dentin. Material and Methods Occlusal enamel was removed from third molars to expose the dentin surface, and the molars were submitted to a caries induction protocol for 15 days. After removal of infected dentin, specimens were conditioned with 37% phosphoric acid (15 seconds) and randomly divided into three groups, according to the type of dentin pretreatment (n=10): NT: no treatment; GT: 2% green tea extract; CLX: 2% chlorhexidine. The etch-and-rinse adhesive system (Adper™ Single Bond 2, 3M ESPE, St. Paul, MN, USA) was applied according to the manufacturer's instructions, and composite resin restorations were built on the dentin. After 24 hours, at 37°C, the resin-tooth blocks were sectioned perpendicularly to the adhesive interface in the form of sticks (0.8 mm2 of adhesive area) and randomly subdivided into two groups according to when they were to be submitted to microtensile bond strength (μTBS) testing: immediately or 6 months after storage in distilled water. Data were reported in MPa and submitted to two-way ANOVA for completely randomized blocks, followed by Tukey’s test (α=0.05). Results After 24 hours, there was no significant difference in the μTBS of the groups. After 6 months, the GT group had significantly higher μTBS values. Conclusion It was concluded that the application of 2% green tea extract was able to increase bond durability of the etch-and-rinse system to dentin. Neither the application of chlorhexidine nor non-treatment (NT - control) had any effect on bond strength after water storage

Avaliação de progênies de café obtidas por cruzamentos das cultivares Icatu e Catimor

The objective of this work was to evaluate the productivity and resistance to leaf rust (Hemileia vastatrix Berk. & Br.) of twenty four F4 coffee progenies from crosses between the Icatu and Catimor cultivars. The experiment was carried out in Três Pontas, Minas Gerais State, in a randomized block design with four repetitions and 25 treatments. The Rubi MG 1192 cultivar was used as control. Coffee bean yield in bags.ha-1 from six harvests (from 2001/2002 to 2006/2007) and leaf rust incidence and severity in the first semester of 2006 were analyzed. The results indicated variability among the evaluated progenies, mainly for grain yield and rust resistance, as confirmed by herdibility traits, which showed a broad range of 31,5% for grain yield and up to 92,8% for rust incidence. This condition, associated with high bean yield, which reached 31,9 bags.ha-1, and with low rust incidence and severity demonstrated the possibility of selecting outstanding progenies from among the studied population, which potentially can be used as productive and commercial cultivars resistant to leaf rust.Objetivou-se avaliar o desempenho em relação à produtividade e resistência à ferrugem de 24 progênies F4 de café originadas do cruzamento entre as cultivares Icatu e Catimor. As progênies foram avaliadas em experimento instalado em Três Pontas, sul do Estado de Minas Gerais na Fazenda Experimental da Epamig. O delineamento foi em blocos casualizados com quatro repetições e 25 tratamentos, 24 progênies do cruzamento mais a cultivar Rubi MG 1192 como testemunha. Para a análise dos dados, adotou-se o esquema de parcela subdividida no tempo. Foram analisadas as características: produção em sacas beneficiadas.ha-1 de seis colheitas: 2001/2002 a 2006/2007 e a incidência e a severidade da ferrugem no primeiro semestre de 2006. Pelos resultados obtidos, verifica-se que as progênies avaliadas apresentam variabilidade, principalmente para a resistência à ferrugem, confirmado pelas estimativas da herdabilidade, que foram de boa magnitude, chegando até o valor de 92,8% para a característica incidência da ferrugem. Essa condição, aliada às médias altas de produção, que chegaram até a 31,9 sacas.ha-1 na média das seis colheitas, à baixa incidência e severidade da ferrugem, demonstrou que é possível selecionar progênies superiores na população estudada, com potencial de serem lançadas como cultivares produtivas e resistentes à ferrugem

Comparison among Feline’s Body Mass Index, Leptin Hormone Serum Level and Body Condition Score to Diagnose Obesity in Domestic Cats

Background: Today, obesity is a condition commonly seen in small animal internal medicine. This condition is defined as excess of body fat resulting from increased energy absorption or reduced energy expenditure, and it is classified as a nutritional and metabolic disorder.  Obesity results from excessive formation of adipose tissue, and can pose severe consequences to the animal's health. It can also become an aggravating factor for several diseases, frequently exerting direct effects on morbidity and mortality.  This study aimed to evaluate feline body mass index (FBMI), and associate this parameter with body condition score (BCS) and leptin hormone serum levels.Materials, Methods & Results: This study was conducted in a private Veterinary Clinic exclusively dedicated to feline care in the neighborhood of Botafogo, city of Rio de Janeiro, Brazil. Ninety-six feline patients (Felis catus) were randomly selected independent of their gender (male or female - intact or not), breed, or age from cats that were submitted for surgical interventions. The population was then divided into two groups according to FBMI: group 1, with non-obese animals (FBMI < 30%), totaling 53 animals; and group 2, with obese animals (FBMI ≥ 30%), totaling 43 animals. Physical examination was conducted on all animals. During this procedure, the weight of the animals was recorded; obesity was determined subjectively using the BCS, and objectively using plasma leptin concentration as assessed by radioimmunoassay (RIA). Leptin concentration in the plasma of the 96 animals included in this study was 13.81 ± 13.06 ng/mL HE. The average for group 1 was 3.85 ± 3.08 ng/mL HE, while the average for group 2 was 26.08 ± 9.61 ng/mL HE. The average leptin concentration in animals with body condition scores 1 and 2 (lean) was 2.53 ± 1.22 ng/mL HE; the average leptin concentration in animals with a BCS of 3 (ideal) was 4.23 ± 3.67 ng/mL HE; the average leptin concentration in animals with body condition scores 4 and 5 (above the ideal weight) was 21.29 ± 12.47 ng/mL HE. Animals with scores 1, 2, and 3 were present only in group 1, with averages of 2.53 ± 1.22 ng/mL HE for animals with scores 1 and 2, and 4.23 ± 3.73 ng/mL HE for animals with a score of 3. Animals with scores 4 and 5 in group 1 had an average leptin concentration of 5.24 ± 4.41 ng/mL HE, and animals with scores 4 and 5 in group 2 had an average leptin concentration of 26.08 ± 9.61 ng/mL HE. In cats, plasma leptin has been determined in experimental studies under controlled conditions, but not in clinical studies. It is possible that this is the first study in which this parameter has been assessed under heterogeneous conditions; therefore, caution should be taken if this technique is used in the clinical routine for determination of obesity in domestic cats.Discussion: Plasma leptin concentration may be a quantitative parameter for evaluation of obesity in dogs, humans, and rodents. Assessment of plasma leptin concentration could be included in obesity monitoring programs for cats and, additionally, constitute a helpful parameter in scientific studies on obesity in this species. In addition to providing descriptive data on obesity in cats in Rio de Janeiro, the results reported in this study may help veterinarians to predict which cats are prone to becoming obese. Prevention of feline obesity can be as or more important than curing it

LEVANTAMENTO FLORÍSTICO DA MATA CILIAR URBANA DO CÓRREGO ÁGUA TURVA EM DOIS VIZINHOS-PR

Objetivou-se com o presente trabalho realizar o levantamento florístico nas margens do Córrego Água Turva localizado no município de Dois Vizinhos-PR. Para o estudo delimitou-se a parte urbana do córrego onde foram identificados por meio de censo todos os indivíduos encontrados na mata ciliar do córrego que, segundo a legislação vigente no período de estudo (Lei 7.511 de 1986), inclui-se toda a vegetação encontrada a uma distância de até 30 metros das margens. Foram identificadas 38 famílias, um total de 738 indivíduos, sendo que entre estes, 663 são exóticos dos quais 419 são exóticos com potencial invasor e apenas 75 são nativos. A família Oleaceae apresentou a maior dominância correspondente a 13,0% do total, não havendo diversidade botânica, sendo representada exclusivamente pelas espécies Ligustrum lucidum, que possui potencial invasor, assim como a Leucena leucocephala e Hovenia dulcis (11,9 %). O manejo e planejamento da mata no entorno do córrego deve levar em consideração a grande quantidade de espécies invasoras encontradas, que interferem na flora e fauna local.

Parâmetros genéticos e seleção genotípica em arroz de terras altas / Genetic parameters and genotype selection in upland rice

Para a sustentabilidade do arroz de terras altas e expansão da área de cultivo, é necessário a obtenção e utilização de cultivares mais produtivas e de grãos com alta qualidade. Para tanto, é necessário a avaliação dos genótipos com alto potencial, considerando os parâmetros genéticos e a interação genótipos x ambientes para identificar aqueles mais adaptados. Dentro dos programas de melhoramento a obtenção das estimativas dos parâmetros genéticos e fenotípicos, ganhos genéticos e do progresso ao longo dos anos são essenciais a fim que se possa avaliar a eficiência do programa na condução e seleção das populações.  Diante do exposto, objetivou-se estimar os parâmetros genotípicos e fenotípicos a fim de verificar a eficiência de seleção de genótipos, visando a obtenção de cultivares superiores no programa de melhoramento de arroz de terras altas da UFLA. Os experimentos do Ensaio de Rendimento de Família (ERF) foram conduzidos no município de Lavras – MG, na Universidade Federal de Lavras, durante as safras 2015/2016, 2016/2017 e 2017/2018.  O delineamento foi de blocos casualizados com duas repetições e parcelas constituídas por duas linhas de 3,0 m. Foram avaliadas as seguintes características produtividade de grãos (kg.ha-1) e número de dias decorridos do plantio ao florescimento. Verificou-se a eficiência na seleção de progênies dos Ensaios de Rendimento de Famílias do programa de melhoramento genético de arroz de terras altas com ganhos ao longo das safras de 187,6 kg.ha-1, para produtividade de grãos e redução no número de dias para o florescimento

In vitro toxicity of Niedenzuella (Tetrapterys) multiglandulosa on bovine embryos

Niedenzuella (Tetrapterys) multiglandulosa, a vine plant found in Brazil, has been correlated to outbreaks of poisoning in cattle and buffaloes, generating economic losses related to the death due to heart failure, miscarriage, abortion, stillbirth, and neonatal mortality. The aim of this study was to examine the embryotoxic potential of the aqueous plant extract on in vitro bovine embryos. In vitro study was performed in five replicates of bovine embryo culture assigned in two groups: control, in vitro embryo culture medium without the aqueous plant extract; treated group, with addition of 2.7mg/mL of aqueous plant extract (10%) to the embryo culture on the sixth day of culture. Cleavage rate was evaluated at day 2 of the cell culture. Viability, hatchability and underdevelopment of blastocysts on the seventh, eighth, and ninth days (D7, D8, and D9, respectively) of culture were assessed under stereoscopic microscope. On day 7, blastocysts were submitted to TUNEL assay to determine apoptotic index. In vitro exposure of bovine embryos to of N. multiglandulosa resulted in reduced embryo development and survival, evaluated by dark cytoplasm indicating poor morphology and poor quality with marked reduction of hatchability. We observed a significant reduction of blastocyst production/number of cleaved embryos (60.6% vs 41.5%); reduction of blastocysts production/total number of matured bovine oocytes (35.1% vs 21.3%); and embryonic hatching rates (38.0% vs 10.0%). However, no effects were observed on the apoptotic rate. In conclusion, aqueous extract of N. multiglandulosa leaves reduces bovine embryo viability in vitro, suggesting possible detrimental effects on embryo development. Key words: apoptosis; blastocyst; toxic plant

Fatores de atraso na alta hospitalar em hospitais de ensino

OBJETIVO Analisar os motivos de atraso na alta hospitalar de pacientes internados em enfermarias de clínica médica. MÉTODOS Foram analisados 395 prontuários de pacientes consecutivos das enfermarias de clínica médica de dois hospitais públicos de ensino: Hospital das Clínicas da Universidade Federal de Minas Gerais e Hospital Odilon Behrens. Foi utilizado o Appropriateness Evaluation Protocol para definir o momento a partir do qual as anotações do prontuário permitiam concluir que a permanência no hospital não mais era adequada. O intervalo entre esse momento e a data da alta hospitalar efetivada definiu o total de dias de atraso na alta hospitalar. Foi utilizado, sistematicamente, instrumento para categorizar os motivos de atraso da alta hospitalar, tendo sido realizada análise de frequências. RESULTADOS O atraso na alta hospitalar ocorreu em 60,0% das 207 internações do Hospital das Clínicas e em 58,0% das 188 internações do Hospital Odilon Behrens. O atraso por paciente foi em média de 4,5 dias no primeiro e 4,1 dias no segundo, o que corresponde à taxa de ocupação de 23,0% e 28,0% em cada hospital, respectivamente. Os principais motivos de atraso nos dois hospitais foram, respectivamente: espera para realização de exames complementares (30,6% e 34,7%) ou para liberação dos laudos dos exames (22,4% e 11,9%) e os relacionados à responsabilidade médica (36,2% e 26,1%), compreendendo a demora na discussão do caso clínico e na tomada de decisão clínica e dificuldades nas interconsultas, respectivamente (20,4% e 9,1%). CONCLUSÕES Foi constatado percentual elevado de atraso na alta hospitalar nos dois hospitais. O atraso foi devido principalmente a fatores relacionados a processos, que podem ser melhorados por intervenções da equipe assistencial e dos gestores. O impacto na média de permanência hospitalar e na taxa de ocupação foi expressivo e preocupante, num cenário de relativa escassez de leitos e longas esperas por internação