Analysing the Time of Bed Availability in Intensive Care Unit of Accident and Orthopaedic Department Using Survival Analysis.

PurposeOptimizing the available resources in a hospital helps to improve the capacity utilization in the respective divisions. Predicting the length of stay (LoS) of patients admitted to Intensive Care Unit (ICU) gives a clear vision to the physicians and the administrative level to improve the productivity and to plan its staffing policy. MethodThe study was carried out for all the patients admitted to the ICU in Accident and Orthopaedic Service to estimate their LoS in ICU using survival analysis. Data obtained were identified as censored or non-censored data and were categorized based on their gender, age and the type of injury. Kaplan-Meier estimates were used to predict the LoS of patients based on the above categories. Finally, the best-fitted survival model, the logistic model was used to identify the significance of gender, age and the type of injury of the patients on their LoS. ResultsThe probability of discharging a female patient within less number of days was higher than that of male patients. Senior adults recorded the highest LoS. When patients were categorized based on the type of injury, highest LoS was recorded by the patients with facial injuries. According to the log-rank test only the levels of age (p value = 0.04) and injuries (p-value = 0.04) show a statistical difference between the respective variable levels. Gender does not show a significance relation with the LoS. ConclusionThe patients' age and the type of injury were significantly related to LoS of ICU patients.

Todavía se recetan medicamentos potencialmente hepatotóxicos a pacientes con enfermedad hepática que reciben atención terciaria: es hora de decir basta

Introduction and aim: Drug-induced liver injury (DILI) manifests as a spectrum of clinical presentations that carries morbidity and mortality. Patients with chronic liver disease (CLD), particularly hospitalized, are at high risk for developing DILI. We aimed to investigate the use of potentially hepatotoxic drugs (PHD) in patients with CLD in a tertiary university hospital. Materials and methods: Adult (≥ 18 years-old) with CLD admitted to the hospital from January 2016 to December 2018 were evaluated regarding PHD, assessing the risk of DILI and liver enzymes behavior after exposure. Results: From 931 hospitalized patients with CLD, 291 (31.3%) were exposed to hepatotoxic drugs during their hospitalization. Of those, 244 (83.8%) were cirrhotic. The most frequent causes of liver disease were hepatitis C (41.2%), followed by alcohol (13.2%), hepatitis C/alcohol (11.7%) and non-alcoholic fatty liver disease (5.8%). Decompensated cirrhosis (46.7%) was the main reason for hospital admission. The most often prescribed PHD were antibiotics (67.7%), cardiovascular drugs (34.4%), neuromodulators (26.1%) and anesthetics (19.9%). After exposure, 113 patients (38.8%) presented significant elevated liver enzymes. Surprisingly, PHD were more often prescribed in GI/Liver unit (48.8%) followed by emergency/intensive care unit (28.5%). A total of 65 patients (22%) died, however in neither case was it possible to safely infer causal relationship among PHD, liver enzymes and death. Conclusion: PHD prescription is frequent in patients with CLD even in a tertiary university hospital and in the gastroenterology and hepatology department, exposing these patients to an additional risk.Introducción y objetivo: La lesión hepática inducida por fármacos (DILI) se manifiesta como un espectro de presentaciones clínicas que conlleva morbilidad y mortalidad. Los pacientes con enfermedad hepática crónica (EHC), en particular hospitalizados, tienen un alto riesgo de desarrollar DILI. Nuestro objetivo fue investigar el uso de fármacos potencialmente hepatotóxicos (FPH) en pacientes con EHC en un hospital universitario terciario. Materiales y métodos: Se evaluó la expossición a FPH en adultos (≥ 18 años) con EHC ingresados en el hospital entre enero de 2016 y diciembre de 2018, evaluando el riesgo de DILI y el comportamiento de las enzimas hepáticas tras la exposición. Resultados: De 931 pacientes hospitalizados con EHC, 291 (31,3%) estuvieron expuestos a fármacos hepatotóxicos durante su hospitalización. De ellos, 244 (83,8%) eran cirróticos. Las causas más frecuentes de enfermedad hepática fueron la hepatitis C (41,2%), seguida del alcohol (13,2%), la hepatitis C / alcohol (11,7%) y la enfermedad del hígado graso no alcohólico (5,8%). La cirrosis descompensada (46,7%) fue el principal motivo de ingreso hospitalario. Los FPH más prescritos fueron antibióticos (67,7%), fármacos cardiovasculares (34,4%), neuromoduladores (26,1%) y anestésicos (19,9%). Tras la exposición, 113 pacientes (38,8%) presentaron elevación significativa de las enzimas hepáticas. Sorprendentemente, los FPH se prescribieron con mayor frecuencia en la unidad GI / Hígado (48,8%) seguido de la unidad de emergencia / cuidados intensivos (28,5%). Un total de 65 pacientes (22%) fallecieron, sin embargo, en ninguno de los casos fue posible inferir con seguridad la relación causal entre el FHD, las enzimas hepáticas y la muerte. Conclusión: la prescripción de FPH es frecuente en pacientes con EHC incluso en un hospital universitario terciario y en el servicio de gastroenterología y hepatología, exponiendo a estos pacientes a un riesgo adicional

Validation of low anterior resection syndrome score in Brazil with Portuguese

Purpose This study was performed to investigate the convergent validity, discriminative validity, and reliability of the Brazilian version of the low anterior resection syndrome (LARS) score in a population with low educational and socioeconomic levels. Methods The LARS score was translated into the Portuguese language by forward- and back-translation procedures. In total, 127 patients from a public hospital in Brazil completed the questionnaires. The convergent validity was tested by comparing the LARS score with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core Module 30 (QLQ-C30) and with patients’ self-reported quality of life. For the discriminative validity, we tested the ability of the score to differentiate among subgroups of patients regarding neoadjuvant radiotherapy, type of surgery, and tumor distance from the anal verge. The test-retest reliability was investigated in a subgroup of 36 patients who responded to the survey twice in 2 weeks. Results The LARS score demonstrated a strong correlation with 5 of 6 items from the EORTC QLQ-C30 (P<0.05) and good concordance with patients’ self-reported quality of life (95.3%), confirming the convergent validity. The score was able to discriminate between subgroups of patients with different clinical characteristics related to LARS (P<0.001). The agreement between the test and retest showed that 86.1% of the patients remained in the same LARS category, and there was no significant difference between the LARS score numerical values (P=0.80), indicating good reliability overall. Conclusion The Brazilian version of the LARS score is a valid and reliable instrument to assess postoperative bowel function in a population with low educational and socioeconomic levels

Hypothalamic S1p/s1pr1 Axis Controls Energy Homeostasis

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Sphingosine 1-phosphate receptor 1 (S1PR1) is a G-protein-coupled receptor for sphingosine-1-phosphate (S1P) that has a role in many physiological and pathophysiological processes. Here we show that the S1P/S1PR1 signalling pathway in hypothalamic neurons regulates energy homeostasis in rodents. We demonstrate that S1PR1 protein is highly enriched in hypothalamic POMC neurons of rats. Intracerebroventricular injections of the bioactive lipid, S1P, reduce food consumption and increase rat energy expenditure through persistent activation of STAT3 and the melanocortin system. Similarly, the selective disruption of hypothalamic S1PR1 increases food intake and reduces the respiratory exchange ratio. We further show that STAT3 controls S1PR1 expression in neurons via a positive feedback mechanism. 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Modelo cognitivo-motivacional para la promoción de la persistencia en Educación Superior: relación entre la organización docente, la competencia del alumnado y el «grit»

The teaching process and the success of learning are closely linked to cognitive and motivational factors. The purpose of this study was to test a multilevel model in higher education students on the relationship between the teaching organization and the dimensions of grit and perceived competence. Participated 3033 students, who answered utility dimension inventories and organization, competition and grit. The results show that at the individual level, the organization by the teaching staff focused on the utility and organization is positively related to the student's scream, this relationship being mediated by the perceived competence. The organizational improvement of the teacher generates student achievements through the positive impact on their competence.«El proceso de enseñanza y el éxito del aprendizaje están estrechamente vinculados a factores cognitivos y motivacionales. Este estudio tuvo como propósito poner a prueba un modelo multinivel en estudiantes de Educación Superior sobre la relación de la organización docente y las dimensiones del grit, mediada por la competencia percibida. Participaron 3.033 estudiantes de cinco países, a los que se les midió la utilidad y organización del docente, la competencia y el grit. Los resultados muestran que, a nivel individual, la organización por parte del profesorado centrada en la utilidad se relacionó positivamente con el grit del estudiante cuando estaba mediada por la competencia percibida. Se sugiere que el profesor mejore su tarea organizativa docente, pues genera mayores logros en el estudiante a través del impacto positivo sobre su competencia

Fertilidade de fêmeas Nelore após inseminação artificial em tempo fixo conforme a contagem de folículos antrais

O objetivo deste trabalho foi determinar o efeito do número de folículos antrais sobre as taxas de concepção de fêmeas Nelore, em programa de inseminação artificial em tempo fixo (IATF). Para isso, 481 fêmeas foram submetidas a um protocolo de IATF e avaliadas quanto à contagem de folículos antrais (CFA) e ao diagnóstico de gestação. Os animais foram agrupados nas categorias de CFA baixa (53). Não houve diferença entre as taxas de concepção obtidas nas categorias de CFA em IATF com uso de gonadotrofina coriônica