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Oseltamivir is a neuraminidase inhibitor that is labeled for prophylaxis and treatment of influenza. We describe a previously healthy 4-month-old infant who tested positive for influenza A and was started on oseltamivir. One hour after receiving his first dose of oseltamivir, the infant had a diaphoretic episode and appeared grey and clammy. The infant was subsequently seen by the primary care physician and referred for admission to the hospital. Approximately 40 minutes after the second dose of oseltamivir in the hospital, the infant's heart rate rose to greater than 300 bpm. An electrocardiogram was suggestive of supraventricular tachycardia. At the time of the event, the infant received 2 doses of adenosine, and oseltamivir was discontinued prior to transfer to a tertiary facility for a higher level of care.
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Mycobacterium tuberculosis (M.tb) is deposited into the alveolus where it first encounters the alveolar lining fluid (ALF) prior contacts host cells. We demonstrated that M.tb-exposure to human ALF alters its cell surface, driving better M.tb infection control by professional phagocytes. Contrary to these findings, our results with non-professional phagocytes alveolar epithelial cells (ATs) define two distinct subsets of human ALFs; where M.tb exposure to Low (L)-ALF or High(H)-ALF results in low or high intracellular bacterial growth rates in ATs, respectively. H-ALF exposed-M.tb growth within ATs was independent of M.tb-uptake, M.tb-trafficking, and M.tb-infection induced cytotoxicity; however, it was associated with enhanced bacterial replication within LAMP-1+/ABCA1+ compartments. H-ALF exposed-M.tb infection of ATs decreased AT immune mediator production, decreased AT surface adhesion expression, and downregulated macrophage inflammatory responses. Composition analysis of H-ALF vs. L-ALF showed H-ALF with higher protein tyrosine nitration and less functional ALF-innate proteins important in M.tb pathogenesis. Replenishment of H-ALF with functional ALF-innate proteins reversed the H-ALF-M.tb growth rate to the levels observed for L-ALF-M.tb. These results indicate that dysfunctionality of innate proteins in the H-ALF phenotype promotes M.tb replication within ATs, while limiting inflammation and phagocyte activation, thus potentiating ATs as a reservoir for M.tb replication and survival.
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ADN Bacteriano/genética , Células Epiteliales/fisiología , Pulmón/patología , Mycobacterium tuberculosis/fisiología , Alveolos Pulmonares/patología , Mucosa Respiratoria/inmunología , Tuberculosis Pulmonar/inmunología , Células A549 , Apoptosis , Adhesión Celular , Citotoxicidad Inmunológica , Replicación del ADN , Células Epiteliales/inmunología , Humanos , Inmunidad Innata , Pulmón/microbiología , Fagocitosis , Alveolos Pulmonares/inmunologíaAsunto(s)
Pacientes Internos/psicología , Enfermeras y Enfermeros , Pase de Guardia/normas , Percepción , Postura , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Relaciones Enfermero-Paciente , Atención de Enfermería/métodos , Calidad de la Atención de Salud/normas , Encuestas y Cuestionarios , Rondas de Enseñanza/métodos , Rondas de Enseñanza/normasRESUMEN
Mycobacterium tuberculosis (M.tb), the causative agent of tuberculosis, is a major public health challenge facing the world. During infection, M.tb is deposited in the lung alveolar space where it comes in contact with the lung mucosa, known as alveolar lining fluid (ALF), an environment that M.tb encounters at different stages of the infection and disease. ALF is abundant in homeostatic and antimicrobial hydrolytic enzymes, also known as hydrolases. Here we demonstrate that ALF hydrolases, at their physiological concentrations and upon contact with M.tb, release M.tb cell envelope fragments into the milieu. These released fragments are bioactive, but non-cytotoxic, regulate the function of macrophages, and thus are capable of modulating the immune response contributing to the control of M.tb infection by human macrophages. Specifically, macrophages exposed to fragments derived from the exposure of M.tb to ALF were able to control the infection primarily by increasing phagosome-lysosome fusion and acidification events. This enhanced control was found to be dependent on fragment-induced interleukin-10 (IL-10) production but also involves the STAT3 signaling pathway in an IL-10-independent manner. Collectively our data indicate that M.tb fragments released upon contact with lung mucosa hydrolases participate in the host immune response to M.tb infection through innate immune modulation.
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Pared Celular/metabolismo , Macrófagos/inmunología , Mycobacterium tuberculosis/inmunología , Mucosa Respiratoria/metabolismo , Tuberculosis Pulmonar/inmunología , Células Cultivadas , Humanos , Hidrolasas/metabolismo , Inmunidad Innata , Interleucina-10/metabolismo , Lisosomas/metabolismo , Macrófagos/microbiología , Fusión de Membrana , Fagocitosis , Fagosomas/metabolismo , Mucosa Respiratoria/patología , Factor de Transcripción STAT3/metabolismoRESUMEN
This report describes four diverse programs of community-engaged research, all of which demonstrated positive health outcomes. Three of the programs were focused on communities of people with diabetes, and one program targeted at-risk young families raising infants and young children. Brief descriptions of each research study and outcomes are presented as well as a discussion of the processes and lessons that were learned from each model of successful interdisciplinary community-university health research partnerships.
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Investigación sobre Servicios de Salud , Estudios Interdisciplinarios , Modelos Teóricos , Características de la Residencia , Niño , Humanos , LactanteRESUMEN
Emerging natural and man-made threats to the health of the nations population require development of a seamless laboratory network to address preventable health risks; this can be achieved only by defining the role of public health laboratories in public and private laboratory service delivery. Establishing defined core functions and capabilities for state public health laboratories will provide a basis for assessing and improving quality laboratory activities. Defining public health laboratory functions in support of public health programs is the beginning of the process of developing performance standards for laboratories, against which state public health laboratories, and eventually local public health and clinical laboratories, will establish and implement best laboratory practices. Public health is changing, and as apart of that change, public health laboratories must advocate for and implement improvements for public health testing and surveillance. These changes are outlined also in the Association of Public Health Laboratories consensus report (Association of Public Health Laboratories. Core functions and capabilities of state public health laboratories: a white paper for use in understanding the role and value of public health laboratories in protecting our nation's health. Washington, DC: Association of Public Health Laboratories, 2000).
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Laboratorios/organización & administración , Administración en Salud Pública , Salud Pública , Laboratorios/normas , Administración en Salud Pública/normas , Estados UnidosRESUMEN
PURPOSE: To assess efficacy of an intervention delivered by an interactive, computer-controlled telephone system to improve individuals' diets. DESIGN: Randomized controlled trial. SETTING: Large multispecialty group practice. SUBJECTS: Two hundred ninety-eight adults who were both sedentary and had suboptimal diet quality. INTERVENTION: Weekly communication for 6 months via a totally automated, computer-based voice system. Among intervention group subjects, the system monitored dietary habits and provided educational feedback, advice, and behavioral counseling. Control group subjects received physical activity promotion counseling. MEASURES: Daily intake of fruits, vegetables, red and processed meats, whole fat dairy foods, and whole grain foods estimated from a food frequency questionnaire. RESULTS: Mean age 45.9 years, 72% women, 45% white, and 45% African-American. Among participants who completed diet assessments, compared with the control group, the intervention raised fruit intake a mean of 1.1 servings per day (95% confidence interval [CI] .4, 1.7). On a 0 to 100 global diet quality score combining all five food groups, intervention participants improved their mean score 9 (95% CI 4, 13) points more than in the control group. The intervention also raised dietary fiber intake 4.0 g/d (95% CI .1, 7.8) and decreased saturated fat, as a proportion of energy intake, by 1.7% (95% CI -2.7, -.7). CONCLUSIONS: This computer-based telecommunications dietary behavior intervention helped improve participants' overall diet.
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Instrucción por Computador , Conducta Alimentaria , Promoción de la Salud/métodos , Teléfono , Adulto , Análisis de Varianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Interfaz Usuario-ComputadorRESUMEN
BACKGROUND: Given the pressure on healthcare budgets, assessing the cost of managing a disease has become a major research focus; yet collection of these data are labor intensive and difficult. Understanding the predictors of cost provides an efficient means of incorporating such information in decision-making concerning new therapies. METHODS: Data from two 12-week multinational trials that collected information on a variety of neurological, functional, and cost parameters for 1341 ischemic stroke patients were examined by means of multiple linear regression. Because the intent is for the model to be predictive, only patient characteristics that can be known at the time of patient presentation or shortly thereafter were evaluated for inclusion in the model. RESULTS: The Barthel Index was the strongest predictor of cost in all models evaluated. Other major predictors, either directly or through their impact on survival, were stroke subtype, neurological impairment, congestive heart failure, and country. A good model fit was obtained, judging by the model statistics (model F:=84, 3 df, P:<0.0001) and the accuracy of the predictions (<3% difference between mean actual and predicted cost). CONCLUSIONS: Through the use of key patient characteristics, this regression model allows for prediction of the cost of stroke care, which may be helpful in the context of therapeutic decisions and budgetary planning purposes. It also provides insight into how specific treatments, through their impact on clinical characteristics, can modify the cost of stroke treatment.
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Costos de la Atención en Salud/estadística & datos numéricos , Modelos Estadísticos , Evaluación de Resultado en la Atención de Salud/economía , Evaluación de Resultado en la Atención de Salud/métodos , Accidente Cerebrovascular/economía , Factores de Edad , Anciano , Australia , Canadá , Demografía , Manejo de la Enfermedad , Europa (Continente) , Femenino , Estado de Salud , Humanos , Modelos Lineales , Masculino , Análisis Multivariante , Programas Nacionales de Salud/economía , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Accidente Cerebrovascular/clasificación , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Tasa de Supervivencia , Estados UnidosRESUMEN
A 45-year-old woman with no history of cancer presented with a radiological and clinical diagnosis of metastatic tumor in the lungs. On the basis of the findings, the patient underwent an extensive investigation attempting to locate a primary tumor. After an unsuccessful workup, the patient was referred for biopsy, which showed findings of bronchiolitis obliterans organizing pneumonia (BOOP). This case illustrates that the clinical, roentgenographic, and CT findings of BOOP are nonspecific and in some cases can be confused with those of metastatic tumor in the lungs.
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Neumonía en Organización Criptogénica/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundario , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Toracoscopía , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: A chronic partially ischemic state may alter the skeletal muscle response to acute ischemia and free radical formation. METHODS: In order to investigate this hypothesis, a chronic ischemic state was established by ligating the right femoral artery of four mongrel dogs. ABIs were decreased from 1.05 +/- 0.25 preligation to 0.54 +/- 0.14 at 6 weeks (P = 0.04). At the end of 8 weeks, the hindlimb was subjected to 3 h of acute ischemia by clamping the iliac artery. The clamp was then released for 2 h of reperfusion. Plasma samples from the right iliac vein were taken during the ischemia-reperfusion period for analysis of cGMP. Tibialis anterior biopsies for Western analysis of eNOS and iNOS were taken upon completion of reperfusion. Comparisons to control dogs subjected to the acute ischemia and reperfusion without prior femoral artery ligation were made. RESULTS: cGMP levels were increased in the controls at 3 h of ischemia (3539 +/- 350) and 2 h of reperfusion (2880 +/- 269). The chronic ischemia group did not develop a corresponding increase in cGMP at 3 h of ischemia (2762 +/- 251) or after 2 h of reperfusion (2102 +/- 130). Western analysis of eNOS and iNOS revealed similar levels in both groups. Analysis of eNOS revealed 0.6429 +/- 0.086 and 0.5916 +/- 0.072 (densitometric units +/- SEM) for study and control dogs, respectively. Analysis of iNOS revealed 0.3401 +/- 0.067 and 0.2475 +/- 0.066 for study and control dogs, respectively. CONCLUSION: Previous ligation of the femoral artery resulting in chronic partial ischemia in this model demonstrated no increase in cGMP following acute ischemia that was not accompanied by a change in eNOS or iNOS levels. Nitric oxide activity is reflected by cGMP levels, which may increase in response to free radicals in the acute setting of complete ischemia.
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GMP Cíclico/sangre , Miembro Posterior/irrigación sanguínea , Isquemia/metabolismo , Enfermedad Aguda , Animales , Western Blotting , Enfermedad Crónica , GMP Cíclico/metabolismo , Densitometría , Perros , Músculo Esquelético/enzimología , Músculo Esquelético/metabolismo , Óxido Nítrico Sintasa/metabolismo , Óxido Nítrico Sintasa de Tipo II , Óxido Nítrico Sintasa de Tipo III , Valores de Referencia , Factores de TiempoRESUMEN
BACKGROUND: Randomized trials have shown a beneficial effect of anticoagulation with warfarin to prevent stroke in atrial fibrillation. It is not known whether the same effect will be obtained in actual practice. The authors conducted a prospective observational study to evaluate the effect of preventive anticoagulation in patients with atrial fibrillation in 2 practice settings in Montreal. METHODS: Of the 1725 outpatients screened between October 1990 and September 1993 at a community hospital and a university-affiliated hospital, 221 with documented atrial fibrillation were enrolled and followed up for a mean of 27 months. Most (75%) of the patients excluded did not meet the inclusion criteria (because of, for example, an artificial heart valve, mitral stenosis, cardiac transplantation or transient atrial fibrillation); the remainder had not completed enrollment before the end of the study. Following the baseline visit, patients were interviewed by telephone every 6 months, and reported events were confirmed through review of the patients' charts. Hazards for stroke and for stroke and transient ischemic attack (TIA) combined were calculated for each of 4 treatment groups: ASA, warfarin, blended treatment and no treatment, based on the type of anticoagulation therapy patients received during the entire observation period. The blended-treatment group consisted of patients who started on one active therapy and switched to the other or who switched treatments more than once. Corresponding rate ratios (RRs) and 95% confidence intervals (CIs) were calculated with reference to the no-treatment group. Cox proportional hazards analysis was used to adjust for differences in patient characteristics. The rates of bleeding episodes were also analysed. RESULTS: On average, the study patients were older (71.6 [standard deviation 9.3] years) and had a higher prevalence of underlying heart disease (52.0%) than those in the randomized trials. Nineteen patients had a first stroke: 4 in the ASA group, 4 in the warfarin group, 4 in the blended-treatment group and 7 in the no-treatment group, for rates of 5.2, 1.8, 5.3 and 5.9 per 100 person-years, respectively. Only warfarin was associated with a significantly lower risk of stroke compared with no anticoagulant therapy (RR 0.31, 95% CI 0.09-1.00). A similar protective effect of warfarin was found for stroke and TIA combined (2.3 v. 6.7 per 100 person-years; RR 0.34, 95% CI 0.12-0.99); the effect of ASA and blended treatment was not significantly different from no treatment. The rate per 100 person-years of any bleeding was not significantly higher for any treatment group (ASA 2.5, warfarin 3.4 and blended treatment 3.5) compared with the no-treatment group (1.9). Patients receiving warfarin had a significantly greater risk of any bleeding event than patients not receiving anticoagulant therapy (RR 1.79, 95% CI 1.07-3.00). INTERPRETATION: The relative effect of anticoagulant therapy with warfarin in preventing stroke in these practice settings was equivalent to that in the randomized trials, although these patients were older and sicker. This preventive treatment is likely to confer additional benefit as it is more widely prescribed.
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Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Trastornos Cerebrovasculares/prevención & control , Warfarina/uso terapéutico , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticoagulantes/farmacología , Trastornos Cerebrovasculares/etiología , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Warfarina/farmacologíaRESUMEN
Worldwide, human immunodeficiency virus (HIV) is transmitted predominantly by heterosexual contact. Here, we investigate for the first time, by examining mononuclear cells obtained from cervicovaginal tissue, the mechanisms whereby HIV type 1 (HIV-1) directly targets cells from the human genital tract. In contrast to earlier findings in mucosal models such as human skin, we demonstrate that the majority of T cells and macrophages but none or few dendritic cells (DC) express the HIV-1 coreceptor CCR5 in normal human cervicovaginal mucosa, whereas all three cell types express the coreceptor CXCR4. To understand the role of coreceptor expression on infectivity, mucosal mononuclear cells were infected with various HIV-1 isolates, using either CCR5 or CXCR4. Unstimulated T cells become rapidly, albeit nonproductively, infected with R5- and X4-tropic variants. However, DC and T cells form stable conjugates which permit productive infection by viruses of both coreceptor specificities. These results indicate that HIV-1 can exploit T-cell-DC synergism in the human genital tract to overcome potential coreceptor restrictions on DC and postentry blocks of viral replication in unactivated T cells. Thus, mononuclear cells infiltrating the genital mucosa are permissive for transmission of both R5- and X4-tropic HIV-1 variants, and selection of virus variants does not occur by differential expression of HIV-1 coreceptors on genital mononuclear cells.
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Células Dendríticas/metabolismo , Genitales Femeninos/virología , VIH-1/fisiología , Receptores CCR5/biosíntesis , Receptores CXCR4/biosíntesis , Linfocitos T/metabolismo , Cuello del Útero/citología , Cuello del Útero/virología , Células Dendríticas/virología , Femenino , Genitales Femeninos/citología , VIH-1/metabolismo , Humanos , Leucocitos Mononucleares/citología , Membrana Mucosa/citología , Fenotipo , Linfocitos T/virología , Vagina/citología , Vagina/virología , Replicación ViralRESUMEN
We prospectively studied 37 HIV-1 uninfected persons engaging in repeated high risk sexual activity with an HIV-1 infected partner, as well as 18 of their infected partners. Only one subject (3%) demonstrated the homozygous 32-bp deletion delta32delta32 of the HIV-1 co-receptor CCR5. CD4+ cells from all high risk subjects except the delta32delta32 CCR5 homozygote were susceptible in vitro to both CCR5-dependent and CXCR4-dependent HIV-1 strains. Median HIV-1 plasma RNA levels of the infected partners were not significantly different from levels of matched infected controls. Thirteen subjects demonstrated HIV-1 specific CTL at one or more visits, and these activities were more commonly observed in persons with the wild type CCR5 genotype. These results indicate that cellular immunity rather than inheritance of the delta32 CCR5 mutation accounts more often for persistently HIV-1-resistant cases.
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Linfocitos T CD4-Positivos/inmunología , Infecciones por VIH/inmunología , VIH-1/inmunología , Adulto , Linfocitos T CD4-Positivos/virología , Femenino , Infecciones por VIH/virología , Humanos , Inmunidad Celular , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Receptores CCR5/genética , Receptores CCR5/inmunología , Receptores CXCR4/genética , Receptores CXCR4/inmunología , Eliminación de Secuencia , Parejas SexualesRESUMEN
For many years psychological studies of the learning process have used a simulated medical diagnosis task in which symptom configurations are probabilistically related to diseases. Participants are given a set of symptoms and asked to indicate which disease is present, and feedback is given on each trial. We enrich this standard laboratory task in four different ways. First, the symptoms have four possible values (low, medium low, medium high, and high) rather than just two. Second, symptom configurations are generated from an expanded factorial design rather than a simple factorial design. Third, subjects are asked to make a continuous judgment indicating their confidence in the diagnosis, rather than simply a binary judgment. Fourth, cumulated performance scores, payoffs, and the availability of a historical summary of the outcomes are varied in order to assess how these treatments modulate performance. These enrichments provide a broader data set and more challenging tests of the models. Using 123 subjects each in 480 trials, we compare five existing learning models plus several variants, including the well-known Bayesian, fuzzy logic, connectionist, exemplar, and ALCOVE models. We find that the subjects do learn to distinguish the symptom configurations, that subjects are quite heterogeneous in their response to the task, and that only a small part of the variation across subjects arises from the differences in treatments. The most striking finding is that the model that best predicts subjects' behavior is a simple Bayesian model with a single fitted parameter for prior precision to capture individual differences. We use rolling regression techniques to elucidate the behavior of this model over time and find some evidence of over-response to current stimuli. Copyright 1998 Academic Press.
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Over the past twenty years many MMPI studies of substance abuse have investigated the complex relationship between personality profile and drug of choice. This work has repeatedly established that alcoholics, heroin, cocaine and polydrug addicts share 4-2/2-4 (Psychopathy and Depression) or 4-8/8-4 (Psychopathy and Thought Disorder) MMPI profiles, but that the substance abuse populations differ in the plane of severity in that general profile. The alcoholics occupy the least disturbed sector, the polydrug abusers the most disturbed level and the heroin and cocaine addicts positions of moderate disturbance. The vast majority of studies, however, cite only group means to buttress their conclusions. Our work probed more deeply into the data using Discriminant Function Analysis. With this methodology we discovered important differences between the groups, previously hidden, which may carry differential treatment implications.
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Cocaína , Etanol , Heroína , MMPI , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/etiología , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Análisis de Varianza , Análisis Discriminante , Femenino , Humanos , MasculinoRESUMEN
Two cases are reported that reiterate the significance of pediatric seat belt usage. Detection of associated injuries is difficult and often delayed. The presence of intra-abdominal free fluid on CT without solid organ injury should indicate the need for surgical intervention. Diagnostic peritoneal lavage usage in pediatric seat belt trauma may need to be re-evaluated. These cases emphasize the above as well as important postinjury clinical changes necessary for earlier diagnosis. A newly designed youth seat belt is presented to help prevent these injuries.
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Yeyuno/lesiones , Vértebras Lumbares/lesiones , Cinturones de Seguridad/efectos adversos , Fracturas de la Columna Vertebral/etiología , Niño , Diseño de Equipo , Femenino , Fracturas Óseas , HumanosRESUMEN
This article introduces the concept of "stimulus field" and describes the role it plays in understanding common thought and language. A stimulus field specifies the psychophysical reality of any particular domain of phenomena. Consistent with various writings in "ecological psychology" this article proposes that cognition about interpersonal phenomena is adapted to the stimulus field of those phenomena and, therefore, that our understanding of the relevant thoughts and language should specify and take account of that reality . The central assumption of this article is that, in the absence of knowing the true stimulus field for interpersonal phenomena, interdependence theory can fruitfully serve as a provisional specification of that field. After an overview of interdependence theory, this article summarizes some of the implications of this strategy. It shows that the theory helps us understand some of the presently known facts about the cognition of interpersonal phenomena and suggests hypotheses about other features of such cognitions. It highlights the abstract level at which interpersonal events are often viewed and identifies advantages and disadvantages of such thought. It suggests the basic terms in which schematic representations of interpersonal relations are cast. It suggests the bases in the stimulus field for the distinctions that people make between "person," "situation," and "interaction" and for the differentiations they make within each of those broad categories. At the same time, it shows why these distinctions are often blurred, identifies the connections in the stimulus field that underlie the implicit meanings of words and the stories people construct, and illustrates how the various connections enter into common assumptions and attributions.
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BACKGROUND AND OBJECTIVES: The study evaluated patient perceptions of side effects related to axillary block (AB) and how they might influence a patient's decisions about subsequent ABs. METHODS: A questionnaire concerning the occurrence and duration of side effects following AB and patient preference for a subsequent AB was completed and returned by each of 1,149 patients. All ABs were performed using a 22 gauge short bevel needle. In all 86.5% had orthopedic surgery, with the remainder vascular access procedures. Three AB techniques and two anesthetic solutions were used. RESULTS: Patient-reported incidences of side effects were bruising, 19.1%; soreness, 39.7%; persistent numbness, 11.0%; and nausea, 10.8%. Bruising was reported more frequently by female patients, those undergoing orthopedic procedures, and those between 20 and 30 and over 80 years of age. Soreness was reported more frequently in orthopedic procedures and by those aged 20 to 30. Technique used did not affect the incidence of side effects or patient willingness to have a repeat AB. Ninety-three percent expressed willingness to have another AB; this was affected by whether the patient experienced a side effect, the duration of the side effect, and by the number of side effects experienced. Those between the ages of 20 and 40 were less willing to have another AB. CONCLUSIONS: Even though 51% of the patients reported at least one side effect, 93% would choose to have another AB, indicating a high overall satisfaction with AB anesthesia, which significantly decreased as the number and duration of side effects increased.
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Bloqueo Nervioso/efectos adversos , Percepción , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Ambulatorios , Axila/inervación , Plexo Braquial , Niño , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agujas , Bloqueo Nervioso/métodos , Estudios ProspectivosRESUMEN
Farm-related injury is often cited as a major factor in rural health care. This is an attempt to obtain an estimate of the frequency of serious farm injuries in Oklahoma. It is apparent that current available data bases are not adequate to be definitive, but mortality data is available, albeit incomplete. One hundred thirty-two deaths were recorded on death certificates for 1987 through 1991, with falls accounting for nearly half. The other data are summarized, and a review of the farm injury literature is presented. In summary, it is clear that farm injuries are a significant problem and steps to prevent them are required.
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Accidentes de Trabajo/mortalidad , Agricultura , Heridas y Lesiones/mortalidad , Femenino , Humanos , Incidencia , Masculino , Oklahoma/epidemiología , Estudios RetrospectivosRESUMEN
The effect of decreased colloid oncotic pressure, as seen in hypoalbuminemia and hypoproteinemia, upon intestinal function has been well delineated in the surgical literature. Patients undergoing abdominal aortic aneurysm resection or aortoiliac or aortofemoral bypass grafts are almost uniformly hypoalbuminemic postoperatively; with these two facts in mind, a prospective, randomized clinical study was undertaken to identify the role of serum albumin concentration on the length of postoperative ileus in this population. The main hypothesis was that patients whose albumin levels dropped below 3.5 gm/dL would have a more prolonged postoperative hospital course as a result of delay in return of bowel function when compared with those patients in whom the low albumin levels were exogenously acutely replenished to > 3.5 gm/dL. Albumin was replaced to a level greater-than or equal to 3.5 g/dL in one group of 37 patients (AR), with a control group of 32 patients (NR) not receiving any albumin. Return of bowel function was measured by the postoperative day that flatus was documented, as well as the postoperative day oral intake was resumed. Mean values were determined for each group, and t tests did not reveal a significant difference in postoperative day of flatus (AR mean = 4.06 days, NR mean = 4.16 days) or postoperative day of oral intake (AR mean = 4.0, NR mean = 3.75). Additional comparisons between the groups involving the number of postoperative days until a regular diet was begun (AR mean = 6.06, NR mean = 5.48) and length of postoperative hospital stay (AR mean = 9.16, NR mean = 8.43) failed to reveal significant differences.(ABSTRACT TRUNCATED AT 250 WORDS)