PIN12: IMPLICATIONS OF APPLYING DIFFERENT NATIONAL GUIDELINES ADDRESSING SURGICAL ANTIBIOTIC PROPHYLAXIS: A CROSS SECTIONAL STUDY OF 386 PATIENTS UNDERGOING TOTAL HIP REPLACEMENT SURGERY

Presentation at the 7th annual Forum for Development Cooperation with Indigenous Peoples, which commenced the 5th-6th of October 2006. The Centre for Sámi Studies hosted the conference at the University of Tromsø, Norway. Full conference report available at http://hdl.handle.net/10037/2996</a

Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule

Introduction: To identify risk factors for early (< three days) intensive care unit (ICU) admission of patients hospitalised with community-acquired pneumonia (CAP) and not requiring immediate ICU admission, and to stratify the risk of ICU admission on days 1 to 3. Methods: Using the original data from four North American and European prospective multicentre cohort studies of patients with CAP, we derived and validated a prediction rule for ICU admission on days 1 to 3 of emergency department (ED) presentation, for patients presenting with no obvious reason for immediate ICU admission (not requiring immediate respiratory or circulatory support). Results: A total of 6560 patients were included (4593 and 1967 in the derivation and validation cohort, respectively), 303 (4.6%) of whom were admitted to an ICU on days 1 to 3. The Risk of Early Admission to ICU index (REA-ICU index) comprised 11 criteria independently associated with ICU admission: male gender, age younger than 80 years, comorbid conditions, respiratory rate of 30 breaths/minute or higher, heart rate of 125 beats/minute or higher, multilobar infiltrate or pleural effusion, white blood cell count less than 3 or 20 G/L or above, hypoxaemia (oxygen saturation < 90% or arterial partial pressure of oxygen (PaO2) < 60 mmHg), blood urea nitrogen of 11 mmol/L or higher, pH less than 7.35 and sodium less than 130 mEq/L. The REA-ICU index stratified patients into four risk classes with a risk of ICU admission on days 1 to 3 ranging from 0.7 to 31%. The area under the curve was 0.81 (95% confidence interval (CI) = 0.78 to 0.83) in the overall population. Conclusions: The REA-ICU index accurately stratifies the risk of ICU admission on days 1 to 3 for patients presenting to the ED with CAP and no obvious indication for immediate ICU admission and therefore may assist orientation decisions

Fatores associados à amamentação na primeira hora de vida

OBJETIVO: Identificar fatores associados à amamentação na primeira hora de vida (Passo 4 da Iniciativa Hospital Amigo da Criança). MÉTODOS: Foi realizado estudo transversal com amostra representativa de parturientes em maternidades do Rio de Janeiro, RJ, entre 1999 e 2001. Foram excluídos recém-nascidos ou mães com restrição ao aleitamento materno, resultando em amostra de 8.397 binômios. Foi adotado modelo Poisson com efeitos aleatórios ao nível das maternidades, em abordagem hierarquizada com três níveis: distal, intermediário e proximal para características maternas, do recém-nascido, e de assistência ao pré-natal e hospitalar. RESULTADOS: Amamentaram na primeira hora de vida 16% das mães. O aleitamento materno nesse período foi menos prevalente entre os recém-nascidos com intercorrências imediatas após o parto (RP = 0,47; IC99% 0,15;0,80); entre as mães que não tiveram contato com os recém-nascidos na sala de parto (RP = 0,62; IC99% 0,29;0,95), as que tiveram parto cesariano (RP = 0,48; IC99% 0,24;0,72); e cujo parto ocorreu em maternidade privada (RP = 0,06; IC99% 0,01;0,19) ou conveniada com o Sistema Único de Saúde (RP = 0,16; IC99% 0,01;0,30). O efeito de contexto das maternidades foi estatisticamente significativo. CONCLUSÕES: Em nível individual, a amamentação na primeira hora de nascimento foi prejudicada por práticas inadequadas nas maternidades, em particular as privadas e conveniadas com o Sistema Único de Saúde. O efeito de grupo das maternidades e a ausência de fatores individuais maternos que expliquem o desfecho sugerem que as mães têm pouco ou nenhum poder de decisão sobre essa amamentação e dependem das práticas institucionais vigentes nas maternidades

Genetic evidence for nonrandom sorting of mitochondria in the basidiomycete Agrocybe aegerita.

We studied mitochondrial transmission in the homobasidiomycete Agrocybe aegerita during plasmogamy, vegetative growth, and basidiocarp differentiation. Plasmogamy between homokaryons from progeny of three wild-type strains resulted in bidirectional nuclear migration, and the dikaryotization speed was dependent on the nuclear genotype of the recipient homokaryon. Little mitochondrial migration accompanied the nuclear migration. A total of 75% of the dikaryons from the fusion lines had both parental mitochondrial haplotypes (mixed dikaryons), and 25% had only a single haplotype (homoplasmic dikaryons); with some matings, there was a strong bias in favor of one parental haplotype. We demonstrated the heteroplasmic nature of mixed dikaryons by (i) isolating and subculturing apical cells in micromanipulation experiments and (ii) identifying recombinant mitochondrial genomes. This heteroplasmy is consistent with the previously reported suggestion that there is recombination between mitochondrial alleles in A. aegerita. Conversion of heteroplasmons into homoplasmons occurred (i) during long-term storage, (ii) in mycelia regenerated from isolated apical cells, and (iii) during basidiocarp differentiation. Homokaryons that readily accepted foreign nuclei were the most efficient homokaryons in maintaining their mitochondrial haplotype during plasmogamy, long-term storage, and basidiocarp differentiation. This suggests that the mechanism responsible for the nonrandom retention or elimination of a given haplotype may be related to the nuclear genotype or the mitochondrial haplotype or both