An 8-step framework for implementing time-driven activity-based costing in healthcare studies

The European Journal of Health Economics - Micro-costing studies still deserving for methods orientation that contribute to achieve a patient-specific resource use level of analysis. Time-driven...     

Depression as a determinant of quality of life in patients with chronic disease: data from Brazil

Background  

Depressive symptoms are associated with impaired quality of life (QOL). However, there are scarce data comparing the magnitude of depression on QOL among persons with different chronic diseases in developing countries. This study aimed to evaluate the impact of depression on QOL in patients with ischemic heart disease (IHD) and end-stage renal disease (ESRD) in hemodialysis.     

Comparative study of eosinophil chemotaxis, adhesion, and degranulation in vitro in ulcerative colitis and Crohn's disease

BACKGROUND: Eosinophils have been identified in tissues from patients with Crohn's disease (CD) and ulcerative colitis (UC) but whether they contribute to IBD pathogenesis is unknown. This study aimed to investigate the functional activity and morphological aspects of peripheral-blood eosinophils from IBD patients compared to those from healthy volunteers (HVs). METHODS: Eosinophils from HVs and CD and UC patients were purified using a Percoll gradient and then a immunomagnetic cell separator. Functional activity in inactivated and previously activated cells was investigated by measuring adhesion to fibronectin and chemotaxis to fMLP, and degranulation was measured by release of eosinophil peroxidase (EPO). Cell morphology was investigated using electron microscopy. RESULTS: Eosinophil adhesion to human fibronectin in both inactivated and PAF-stimulated and PMA-stimulated eosinophils was markedly higher in patients with CD than in either patients with UC or HVs. Similarly, the chemotactic response was markedly higher in eosinophils isolated from CD patients than in those isolated from UC patients or HVs. Baseline EPO release was higher in eosinophils isolated from UC patients than in those isolated from HVs or CD patients. Stimulation with fMLP or PMA did not further increase EPO release in cells from UC or CD patients. Comparable expression of MAC- 1 and VLA-4 adhesion molecules was observed on the surfaces of eosinophils from all groups, and an greater number of granules was noted in the eosinophils from UC patients than in those from CD patients. CONCLUSIONS: Our results indicate that peripheral-blood eosinophils are potentially primed and activated in IBD patients. Whether the differences in the morphology and functional responses of eosinophil from UC and CD patients reflect differences in disease phenotype remains to be elucidated.     

A comparison between the early and mid-term results of surgical as opposed to percutaneous closure of defects in the oval fossa in children aged less than 6 years

OBJECTIVES: To compare surgical as opposed to percutaneous interventional closure of isolated atrial septal defects in the oval fossa in terms of hospital stay, efficacy, and complications, and to study the respective role of the two techniques in current practice. METHODS: Between January 1998 and April 2004, 126 out of 1210 patients treated at our institution for closure of an isolated defect in the oval fossa were aged less than 6 years. The mean age of these 126 patients at procedure was 4.2 plus or minus 1 year. The ratio of females to males was 74 to 52. RESULTS: Of the patients, 62% were treated successfully using a percutaneous approach. The groups treated surgically or percutaneously did not differ for age, gender, or indications for treatment. No deaths occurred. The rates of total and major complications were higher in the group undergoing surgical closure, at 34% versus 9%, p less than 0.0001, and 10.5% versus 1%, p equal to 0.01, respectively. Embolisation of the device requiring subsequent surgery occurred in 1% of patients. The stay in hospital was shorter in those closed percutaneously, at 3.2 plus or minus 0.9 days versus 6.8 plus or minus 2.8 days, p equal to 0.0001. During a mean follow-up of 3.4 plus or minus 1.9 years, no major complications occurred in either group, and symptoms improved significantly in both groups. Additional sequels occurred in 2 patients who had major complications subsequent to surgical closure. CONCLUSIONS: Even in young children, it is both feasible and safe to close defects in the oval fossa percutaneously. Compared to surgical closure, the transcatheter approach allows a shorter stay in hospital, and has a lower rate of complications. Early and mid-term follow-up has confirmed the safety and efficacy of both techniques.     

Solitary median maxillary central incisor syndrome and holoprosencephaly: a case report

Solitary median maxillary central incisor syndrome (SMMCIS) is a rare anomaly that affects 1 in 50,000 live births. Of unknown etiology, SMMCIS is characterized by the presence of a single central incisor located on the maxillary midline and may be associated with developmental defects and systemic alterations. SMMCIS also is associated with short stature, mild forms of deviation in craniofacial morphology, and intellectual disability. The purposes of this paper were to: describe the clinical case of an 8-year-old boy with a permanent central incisor located at the midline in association with holoprosencephaly; and highlight the most important aspects related to diagnosis and treatment of solitary median maxillary central incisor syndrome.     

Deiodinase-mediated thyroid hormone inactivation minimizes thyroid hormone signaling in the early development of fetal skeleton

Thyroid hormone (TH) plays a key role on post-natal bone development and metabolism, while its relevance during fetal bone development is uncertain. To study this, pregnant mice were made hypothyroid and fetuses harvested at embryonic days (E) 12.5, 14.5, 16.5 and 18.5. Despite a marked reduction in fetal tissue concentration of both T4 and T3, bone development, as assessed at the distal epiphyseal growth plate of the femur and vertebra, was largely preserved up to E16.5. Only at E18.5, the hypothyroid fetuses exhibited a reduction in femoral type I and type X collagen and osteocalcin mRNA levels, in the length and area of the proliferative and hypertrophic zones, in the number of chondrocytes per proliferative column, and in the number of hypertrophic chondrocytes, in addition to a slight delay in endochondral and intramembranous ossification. This suggests that up to E16.5, thyroid hormone signaling in bone is kept to a minimum. In fact, measuring the expression level of the activating and inactivating iodothyronine deiodinases (D2 and D3) helped understand how this is achieved. D3 mRNA was readily detected as early as E14.5 and its expression decreased markedly ( approximately 10-fold) at E18.5, and even more at 14 days after birth (P14). In contrast, D2 mRNA expression increased significantly by E18.5 and markedly ( approximately 2.5-fold) by P14. The reciprocal expression levels of D2 and D3 genes during early bone development along with the absence of a hypothyroidism-induced bone phenotype at this time suggest that coordinated reciprocal deiodinase expression keeps thyroid hormone signaling in bone to very low levels at this early stage of bone development.     

Pollen analysis of Holocene sediments from the Poço das Antas National Biological Reserve, Silva Jardim, Rio de Janeiro, Brazil

The Po?o das Antas National Biological Reserve is located in Rio de Janeiro State, southeast Brazil. This paper presents information on past environmental characteristics of the area through pollen analysis. Two sedimentary columns were collected and five samples were selected for radiocarbon dating. The following ages of the columns from bottom to top were detected: column 1 - 1.20-1.16 m: 6080 +/-40 years BP, 0.775-0.735 m: 4090 +/-40 years BP, 0.385-0.345 m: 1880 +/-80 years BP; column 2 - 1.22-1.18 m: 3520 +/-40 years BP, 0.23-0.19 m: 1810 +/-40 years BP. Three samples from column 1 and two samples from column 2 were selected for pollen analysis: 1.20 m, 0.77 m and 0.37 m of column 1 and 1.22 m and 0.21 m of column 2. Chemical treatment followed standard methodology. The palynological analysis shows that around 6080 years BP the study area was dominated by a rain forest and from around 4090 years BP the vegetation changed to a fragmented forest, restricted to low hills and surrounded by an open area of grassland and pioneer plants, swamps and peat areas. The pollen assemblage of the samples 3520, 1880 and 1810 years BP suggest the permanence of this kind of vegetation between 4000 years BP and the actual.     

Antimicrobial action of four herbal plants over mixed-species biofilms of Candida albicans with four different microorganisms

This study aimed to evaluate the antimicrobial effect of four herbal plants glycolic extracts over mixed-species biofilm composed of Candida albicans (C. albicans) and another pathogenic bacterium as alternative therapy to be investigated. Four plants extract of Pfaffia paniculata roots; Hamamelis virginiana leaf, Stryphnodendron barbatiman tree bark and Gymnema sylvestre stem and leaves were tested over multi-species biofilm of C. albicans (ATCC 18804) and Streptococcus mutans (ATCC 35688), Staphylococcus aureus (ATCC 6538), Enterococcus faecalis (ATCC 4083) or Pseudomonas aeruginosa (ATCC 15442) for 5 min and 24 h and colony forming units per millilitre was calculated. The data were analysed using Kruskal–Wallis with Dunn's test (p ≤ 0.05). All tested extracts showed antimicrobial action over the mixed-species biofilms after 24 h. Some extracts eliminated totally the biofilms. The glycolic extract of P. paniculata, H. virginiana, S. barbatiman and G. sylvestre are effective over mixed-species biofilms and may be indicated as endodontic irrigant or intracanal medication.