Indicators and standards proposal for the evaluation of the quality of hospital care: the case for bronchial asthma

The objectives of this article are to propose indicators for evaluation of the quality of hospital management of bronchial asthma patients, based on explicit criteria from literature reviews. The central problem identified in the literature review is the erroneous evaluation of severity of asthma crises, either by patients and their relatives, or by health professionals at all levels of care, causing serious consequences not only for the patient, but for society as a whole. Mortality figures indicate that from 1980 to 1990, an average of 2000 deaths per year from asthma occurred in Brazil, of which 70% occurred in hospital. Asthma was the fourth cause of hospitalization (hospital admissions), in the state of Rio de Janeiro in 1993. Only 12% of the admissions that resulted in death made use of the ICU. The above information highlights the need for a thorough evaluation of hospital care of bronchial asthma in Brazil, including a review of all admissions resulting in death and reviews of a sample of all bronchial asthma admissions. Proposed criteria are for this evaluation include: severity of the crise, treatment prescribed, information given to the patient and their relatives, and follow-up appointments made after discharge from hospital.     

Congenital pulmonary atresia with ventricular septal defect: angiographic and surgical correlates

Of 181 patients with severe congenital pulmonary atresia and ventricular septal defect or "type IV truncus" (an obsolete term), all but 11% had true central pulmonary arteries. These arteries were demonstrable by large serial biplane angiograms using multiple selective injections into collateral vessels, frequent photographic subtraction, and occasional pulmonary vein-wedge angiograms. These techniques are extremely important for accurate diagnosis and in planning corrective or palliative surgery, which was done in 77% of patients with pulmonary arteries.     

The use of the female condom by women in Brazil participating in HIV prevention education sessions.

OBJECTIVES: To study HIV-positive women and women at risk of becoming infected with HIV who attended HIV prevention education group sessions at a university hospital in Brazil and to compare the use of the female condom and the male condom by these two groups of women. METHODS: The study subjects were 165 women participating in HIV prevention education group sessions at the Medical School Hospital of Ribeir?o Preto of the University of S?o Paulo, in the city of Ribeir?o Preto, S?o Paulo, Brazil. Women could be enrolled in the study from August 2000 to June 2001, and the follow-up observation time period was from August 2000 to July 2001. Male condoms and female condoms were freely distributed to all the participants at the end of each educational session and also at the end of each follow-up visit that the participants made. Each woman took part in an initial interview and was asked to return monthly. At each follow-up visit an additional short interview was carried out in order to investigate use of the male condom and of the female condom. Variables that were examined for the study included age, education, ethnic group, marital or relationship status, number of children, the women's use of male condoms and female condoms, commercial sex (whether the women had ever had sex in exchange for money, gifts, or favors), and previous knowledge of the female condom. RESULTS: The 165 women studied fell into the following three categories: 132 of them (80.0%) were HIV-positive, 26 of them (15.8%) had a sexually transmitted disease (STD) other than HIV and did not have an HIV-positive partner, and 7 of them (4.2%) had an HIV-positive partner but did not have HIV or any other STD. The women ranged in age from 15 to 64 years, with a mean of 30.3 years. Of the women in the study, 69.7% of them were married or were cohabitating, and 90.9% of them had a sexual partner. Just over two-thirds of the women had seven years of formal schooling or less. Out of 163 women, a total of 31 of them (19.0%) had never used the male condom with a partner, and 49 of the 163 (30.1%) had not used a male condom at the time of the last sexual intercourse. Out of the 165 women, 74 of them (44.8%) returned for at least one follow-up visit. Of these 74 women, 58 of them (78.3%) reported using the female condom between the initial interview and the first follow-up visit. The majority of the 74 women who returned for a visit liked using the female condom, and the women reported that their partners also generally accepted the female condom. In comparison to women at risk of HIV, HIV-positive women were more likely to have used the male condom with a partner before the initial interview. Women who continued returning over a longer follow-up period were more likely to have used the female condom at the time of the last sexual intercourse. No association was found between female condom use at the time of last sexual intercourse and the woman's HIV infection status. CONCLUSIONS: In comparison to the women at risk of HIV, the HIV-positive women in our study were more likely to use male condoms with their partners, to return for follow-up visits, and to have a longer follow-up period. The acceptance of the female condom among the HIV-positive women in this study, as reported at their first follow-up visit, appears to be similar to the acceptance of the female condom among women in general in Brazil.     

The gain of the baroreflex bradycardia is reduced by microinjection of NMDA receptor antagonists into the nucleus tractus solitarii of awake rats

The baroreflex activation with phenylephrine infusion produces a bradycardic response. In the present study, the role of NMDA receptors in the nucleus tractus solitarii (NTS) in the processing of the parasympathetic component of the baroreflex was evaluated using acid phosphonivaleric (AP-5), a selective NMDA receptor antagonist. Baroreflex activation was performed before and after bilateral microinjection of AP-5 into the intermediate commissural NTS (0.5 mm lateral to the midline). Microinjection of the vehicle (saline, 0.9%) or a dose of 2 nmol/50 nl of AP-5 into the NTS produced no effect on the gain of the baroreflex while a dose of 10 nmol/50 nl of AP-5 produced a significant reduction in the gain of the baroreflex 2 min after microinjection [-1.43+/-0.22 vs. -0. 43+/-0.03 bpm/mmHg, (n=6)], with a return to control levels 10 min after the microinjections. The dose of 10 nmol/50 nl was selective for NMDA receptors considering that the cardiovascular responses to microinjection of AMPA (0.05 pmol/50 nl), a non-NMDA receptor agonist, were not affected by this dose of AP-5 and the responses to microinjection of NMDA (2 nmol/50 nl) were blocked. The data show that the bradycardic response to baroreflex activation was blocked by AP-5 microinjected into the NTS, indicating that the neurotransmission of the parasympathetic component of the baroreflex is mediated by NMDA receptors in the NTS.     

Cadmium, mercury and lead in medicinal herbs in Brazil.

Samples of herbal medicine used in Brazil were analyzed, after nitric digestion, for the content of cadmium, mercury and lead, by atomic absorption spectrophotometry. Fifteen samples of ginkgo biloba (Ginkgo biloba), 13 of celastraceae (Maytenus ilicifolia), 14 of cascara buckthorn (Rhamnus purshiana), 13 of eggplant (Solanum melongena), 15 of horse chestnut (Aesculus hippocastanum), 13 of Brazilian ginseng (Pffafia glomerata), 17 of centella asiatic (Hydrocotyle asiatica), 13 of guarana (Paullinia cupana), 12 of artichoke (Cynara scolymus) and five samples of chlorella (Chlorella pyrenoidosa) were analyzed. Cadmium, mercury and lead were not detected (limit of quantifications of 0.20, 0.01 and 2.0 mg/kg, respectively) in any sample of artichoke, eggplant and guarana. Cadmium was found in samples of the other medicinal herbs at levels up to 0.74 microg/g and mercury up to 0.087 microg/g. Three samples of horse chestnut contained 153, 156 and 1480 microg Pb/g, while the highest concentration found in the other samples analyzed was 22 microg Pb/g. The estimated lead intake through the consumption of horse chestnut reached 440% of Provisional Tolerable Weekly Intake (PTWI), and might be of concern to consumers if the medicine was taken on a long-term basis. Cadmium and mercury exposure through the herbal medicines does not appear to be of health concern.     

Investigation of Genetic Polymorphisms Related to the Outcome of Radiotherapy for Prostate Cancer Patients

The purpose of this study was to evaluate the association between ATM, TP53 and MDM2 polymorphisms in prostate cancer patients and morbidity after radiotherapy. The presence of ATM (rs1801516), TP53 (rs1042522, rs1800371, rs17878362, rs17883323, and rs35117667), and MDM2 (rs2279744) polymorphisms was assessed by direct sequencing of PCR fragments from 48 patients with histologically proven prostate adenocarcinoma and treated with external beam radiation. The side effects were classified according to the Radiation Therapy Oncology Group (RTOG) score. The results showed no association between clinical characteristics and the development of radiation toxicities (P > 0.05). The C>T transition in the position 16273 (intron 3) of TP53 (rs35117667) was significantly associated with the risk of acute skin toxicity (OR: 0.0072, 95% CI 0.0002–0.227, P = 0.003). The intronic TP53 polymorphism at position 16250 (rs17883323) was associated with chronic urinary toxicity (OR: 0.071, 95%CI 0.006–0.784, P = 0.032). No significant associations were found for the remaining polymorphisms (P > 0.05). The results show that clinical characteristics were not determinant on the developing of radiation sensitivity in prostate cancer patients, and intronic TP53 polymorphisms would be associated with increased acute and chronic radiation toxicities. These observations corroborate the importance of investigating the genetic profile to predict adverse side effects in patients undergoing radiotherapy.