Planning the hospital discharge of patients with diabetes: the construction of a proposal

The acute and chronic complications that patients with diabetes and their families have to deal with after hospital discharge may be a consequence of the deficiencies in the educational process across hospitalization and the formal preparation for discharge. The objective of this study is to present a proposal of the plan for hospital discharge of adult patients with diabetes. A literature review on the hospital discharge of the assessed population was performed, including articles published between 2004 and February 2009. Taking the literature into consideration, a flier was created to guide the discharge process. The flier lists the information that should be collected and worked with the patient during the first four days of hospitalization, considering their individual needs and the Ineffective self health management. The discharge must be inserted in the Nursing Process, as nurses have an essential role in identifying the needs of patients and their families. The flier helps to identify the patient's needs and the actions to be performed by the team.     

Role of Smoking and Type 2 Diabetes in the Immunobalance of Advanced Chronic Periodontitis

Background : This study evaluates the tissue levels of interleukin (IL)‐17⁺, IL‐15⁺, Foxp3⁺ cells, fibrosis, and plasma B‐cell infiltration in sites with chronic periodontitis in smokers and subjects with type 2 diabetes. Methods: Gingival biopsies were harvested from the following groups: systemically and periodontally healthy subjects (healthy group, n = 10); non‐smokers and subjects with advanced periodontitis and without diabetes (non‐risk factor/periodontitis group, n = 10); heavy smokers with advanced periodontitis and without diabetes (smoking/periodontitis group, ≥20 cigarettes per day for at least the past 5 years, n = 10); and non‐smoking poorly controlled subjects with diabetes (glycated hemoglobin levels ≥9%) with advanced periodontitis (diabetes mellitus/periodontitis group [DMP], n = 10). The number of IL‐17⁺, IL‐15⁺, and Foxp3⁺ cells was analyzed by immunohistochemistry, whereas the amount of fibrosis and plasma B‐cell infiltration in gingival tissue was analyzed by histomorphometry. Results: The number of Foxp3⁺ cells was significantly higher in the periodontitis groups compared to the healthy group (P <0.05). The DMP group presented higher levels of Foxp3⁺ cells than other periodontitis groups (P <0.05). The levels of IL‐15⁺ and IL‐17⁺ cells and the amount of fibrosis were higher in the DMP group than in the other groups (P <0.05). There was a trend for a decreased B‐cell infiltration in the DMP group (P >0.05). There was a slightly significant negative correlation between B‐cell infiltration and the amount of fibrosis (P <0.05). Conclusion: Upregulation of IL‐17⁺, IL‐15⁺, and Foxp3⁺ cells and increased amounts of fibrosis were observed in chronic periodontitis sites in subjects with type 2 diabetes, suggesting that periodontitis development in these subjects may be influenced by the T helper 17/T regulatory axis.     

A 57 year old man with chronic renal failure and cardiac tamponade who developed ischemic hepatitis

Ischemic hepatitis is an infrequent entity, usually associated with low cardiac out put. We present a case of a 57 year-old man with chronic renal failure and cardiac tamponade who developed elevation of serum alanine transferase level of 5,054 U/L, aspartate transferase level of 8,747 U/L and lactate dehydrogenasa level of 15,220 U/L. The patient developed hepatic encephalopathy and hypoglycemia. Liver Doppler ultrasound was normal. He was seronegative for HBV and HCV, drugs list was scrutinized for the names of known hepatotoxins. Ischemic hepatitis was diagnosed. The hypoglycemia and encephalopathy were solved and the patient was discharged with normal transaminase levels. Ischemic hepatitis is typically preceded by hypotension, hypoxemia, or both. As one would expect, the most common cause of sustained systemic hypotension is cardiovascular disease. Liver biopsy is usually not necessary. The best treatment is support measures and correct the underlying condition.