Assessing Alcohol Dependence in Hospitalized Patients

Alcohol misuse is generally not detected in hospital settings. the goal of this study was to estimate the prevalence of alcohol abuse and dependence in hospitalized patients in a university hospital in São Paulo (Brazil). Patients were randomly selected from all hospital admissions. the final sample consisted of 169 adult inpatients. Two screening tools were used: the Short Alcohol Dependence Data (SADD) and the CAGE questionnaires. in this sample, 25.4% of patients could be considered alcohol dependent according to the CAGE questionnaire, whereas 32.9% of patients fulfilled the criteria according to the SADD. the only predictor of alcohol dependence was gender; male inpatients were 3.2 times more prone to alcohol dependence with female inpatients. All inpatients should be systematically screened for alcohol use disorders. the choice of the screening tool will depend on whether the goal is to identify inpatients with hazardous drinking behaviors or with established alcohol-related problems. To maximize proper case identification, the CAGE questionnaire should be used as a first-step screening tool, and patients who screen positive on this scale should be subsequently administered the SADD questionnaire to assess the severity of the condition.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, São Paulo Sch Med, Dept Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo Sch Med, Dept Psychiat, São Paulo, BrazilWeb of Scienc

Correlation between avascular necrosis and early stabilization of proximal femoral fractures in childhood

OBJETIVE: This study was developed with the main purpose of evaluating treatment results of proximal femoral fractures in a series of cases. We sought to observe the influence of the most frequent complications on the final results after a minimum follow-up of 2 years. We have especially considered the relationship between development of avascular necrosis and time between the accident and therapeutic intervention. METHOD: We retrospectively studied proximal femoral fractures in 29 patients under 14 years of age from 1988 to 2007. The following parameters were analyzed: sex, age, mechanism of injury, fracture classification (Delbet), treatment, complications (pseudoarthrosis, coxa vara, leg length discrepancy and avascular necrosis), time for surgery, and results (Ratliff). Statistical analysis was performed according to the descriptive evaluation of each parameter by using Fisher's exact test. RESULTS: Five (17.2%) patients had avascular necrosis, 3 of whom (60.0%) were older than 10 years of age. Seventy-three point three percent of patients treated in the first 24 hours showed good results. The most common cause of fracture was traffic accident (44.8%). The best results were observed in patients who were treated surgically; 41.4% developed some type of complication. CONCLUSIONS: Among the 29 patients treated, 58.6% had good, 27.6% had regular and 13.8% had poor results according to Ratliff criteria. When conservative treatment was applied, only 17.0% had good results, while surgical intervention results were 69.3% good. In addition, we obtained 73.3% good results when surgery was performed within the first 24 hours and only 42.8% good results in patients submitted to surgery after this period. Patients operated in the first 24 hours developed avascular necrosis in 13.3% of cases, while 21.4% of those operated after that period developed this complication.OBJETIVO: Desenvolvemos este trabalho, com o intuito de avaliar o resultado do tratamento de pacientes portadores de fraturas do fêmur proximal, em uma série de casos. Procuramos observar a influência das complicações mais prevalentes nos resultados finais após o mínimo de dois anos de seguimento. Correlacionamos especialmente a instalação da necrose avascular e o tempo entre o acidente e a instituição da terapêutica. MÉTODOS: Estudamos, retrospectivamente, 29 pacientes com fraturas da extremidade proximal do fêmur, com idade inferior a 14 anos entre 1988 e 2007. Analisamos as seguintes variáveis: sexo, idade, mecanismo de trauma, classificação da fratura (Delbet), tratamento realizado, complicações (pseudartrose, deformidade em varo, anisomelia e necrose avascular), tempo para cirurgia e resultado (Ratliff). Obtivemos uma análise descritiva individual de cada variável. Os testes foram utilizados de acordo com a adequação das premissas de normalidade e para avaliação utilizamos o teste exato de Fisher. RESULTADOS: Obtivemos cinco (17,2%) pacientes com necrose avascular sendo três (60,0%) com idade superior a 10 anos; 73,3% dos pacientes tratados nas primeiras 24 horas apresentaram bons resultados; a causa mais comum de fratura foi acidente automobilístico (44,8%); os melhores resultados foram observados nos pacientes tratados cirurgicamente; 41,4% evoluíram com algum tipo de complicação. CONCLUSÕES: Entre os 29 pacientes tratados, segundo os critérios de Ratliff, obtivemos 58,6% de bons, 27,6% de regulares e 13,8% de maus resultados. Quando aplicado o tratamento incruento, obtivemos apenas 17,0% de bons resultados, enquanto que após o tratamento cirúrgico obtivemos 69,3%. Da mesma forma, observamos que houve 73,3% de bons resultados quando a cirurgia foi realizada nas primeiras 24 horas e apenas 42,8% nos pacientes submetidos à intervenção terapêutica após este período. Pacientes submetidos à cirurgia nas primeiras 24 horas evoluíram com necrose da cabeça do fêmur em 13,3%, enquanto os que foram operados após este período tiveram esta complicação em 21,4% dos casos.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Clínica da Disciplina de Ortopedia PediátricaUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Disciplina de Ortopedia PediátricaUNIFESP, Depto. de Ortopedia e TraumatologiaUNIFESP, EPMUNIFESP, Depto. de Ortopedia e Traumatologia Clínica da Disciplina de Ortopedia PediátricaUNIFESP, Depto. de Ortopedia e Traumatologia Disciplina de Ortopedia PediátricaSciEL

Natural forest regeneration in abandoned sugarcane fields in northeastern Brazil: floristic changes

Surveys were undertaken to examine the floristic changes during secondary succession in three areas of 12 and three of 20-year-old secondary forests in Pernambuco State, Brazil. Two hundred and six species were identified, with 136 being found in the 12-year-old secondary forest and 161 species in the 20-year-old forest. Fabaceae and Myrtaceae were the most important families, increasing in species numbers with regeneration age. Of the 216 species, 115 were trees, 48 shrubs, 16 herbaceous plants, and 24 woody lianas, without significant differences between the two regeneration site ages. NMDS analysis revealed a formation of two floristic groups, distinguishing secondary and mature forests, with a further division within secondary forests in accordance with the time since abandonment. Similarity analysis ANOSIM confirmed the significance of the groups, which had floristic composition significant distinct (R=0.96) and 63% of dissimilarity (SIMPER). However, the sharing of 68 arboreal species between the secondary and mature forests suggests a floristic convergence. DCA analysis of the arboreal component as well as the other plant habits suggested that the separation of the subgroups is correlated with physical and chemical variables of the soils. All of these results indicate that, within the chronosequence analyzed, the velocity and direction of the floristic composition during secondary succession was influenced not only by the time of their abandonment, but also by a wide range of environmental variables

Floristic and structure of the arboral community of a regenerating fragment of Atlantic Forest, Igarassu, Pernambuco, Brazil

Understanding secondary forest structure and functioning is essential for future planning of effective use and/or recompositioning of such areas. The secondary succession process is influenced by the characteristics of componente species, their interaction with other species and with abiotic components. Thus, the objective of the current study was to evaluate the vegetation structure, dispersion syndromes and pollination of a secondary forest fragment with 5 years of regeneration in the Atlantic Forest landscape of Pernambuco, northern Brazil. A total of 30 permanent 10 x 10 m plots with 10 m separations were used for canopy sampling (i.e., all woody individuals with stem diameter at 1.30 m (DBH) greater than 5 cm. Floristic composition analysis recorded 32 species from 21 families. Absolute density was 150 individuals with basal area of 4.787 m² ha-1, and the Shannon-Weaver index (H ‘) was 2.960. The family with the highest number of species was Melastomataceae, while those with greatest abundance were Malpighiaceae (26) and Cecropiaceae (14). Species with the highest Importance Values included Byrsonima sericea (49.28%), Cecropia pachystachya (38.49%) and Bowdichia virgilioides (37.19%). The predominant tree species dispersal syndrome was zoochory (72 species), and the predominant pollination syndrome was melitophilia. Arboreal individuals were mostly recorded in the initial diameter and height classes, indicating that the study area is in the initial stage of succession

Cochlear dysfunction and microvascular complications in patients with type 1 diabetes mellitus

Abstract Sensorineural hearing impairment has been associated with DM, and it is probably linked to the same pathophysiological mechanisms as well-established in microvascular diabetes complications. The study of otoacoustic emissions (OAEs) is useful to identify subclinical cochlear dysfunction. Therefore, the aim of this study was to evaluate the association between abnormal OAEs responses, diabetic kidney disease (DKD) and diabetic cardiac autonomic neuropathy (CAN). We performed a cross-sectional study with 37 type 1 DM patients without auditory symptoms, submitted to the study of Distortion Product Otoacoustic Emissions (DPOAEs) and screened for DKD and CAN. The otoacoustic emissions responses were considered abnormal in 27/37 (73%) patients. A correlation was found between abnormal OAEs responses and presence of DKD (r = 0.36, p < 0.05), and 14/16 (88%) patients with a lower amplitude of OAEs in 8 kHz frequency band presented DKD. Abnormal OAEs responses in the 6 kHz frequency band were correlated with the presence (r = 0.41, p = 0.01) and severity of CAN (r = 0.44, p < 0.001). Additionally, 7/9 (78%) patients with abnormal OAE responses in this frequency also presented abnormal CAN scores. Our results suggest that abnormal otoacoustic emissions responses in high frequency bands are associated with diabetes microvascular complications and could be a risk marker for DKD and CAN, presenting low sensitivity and high specificity. Therefore, assuming that hearing impairment is a pre-clinical stage of hearing loss, performing distortion product otoacoustic emissions in T1DM patients with microvascular complications could be useful to identify those who would be benefit with regular audiologic follow up and tighter diabetes control

Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022