The role of electronic merges in an integrated delivery system

The electronic-only merge method poses a serious challenge to HIM management for ensuring that all clinical documentation for patient care is provided in a timely manner. The organization must be aware of all of the issues affecting the departments so that informed decisions can be made before, during, and after the project. This approach can be successful with comprehensive planning, meticulous procedures for record retrieval and chart folder updating, and extensive staff training. The proactive, traditional merge approach remains the community standard. However, the reactive, electronic-only merge approach has found a niche and can be a viable, cost-effective option when faced with time and budgetary constraints. However, a combination of these approaches may provide the best solution, depending upon an organization's resources, time requirements, and strategic goals.

Public awareness and attitudes toward epilepsy in different social segments in Brazil

PURPOSE

To assess public awareness and attitudes toward epilepsy in Brazilians of different cultural and socioeconomic backgrounds.

BACKGROUND

Several studies have examined public awareness and attitudes toward epilepsy in various countries but there are no equivalent data for Brazil or South America.

MATERIAL AND METHODS

We have applied the survey proposed by Caveness and Gallup, with some modifications and adaptations to four groups (I-IV) of subjects: I--105 individuals accompanying patients to the Ophthalmologic outpatient clinic of the Hospital das Clínicas of the State University of Campinas (UNICAMP); II--93 students recently admitted to medical and nursing school; III--101 senior non-medical students; and IV--69 senior medical students. Group II, III, and IV were students at UNICAMP.

RESULTS

Individuals with a low socioeconomic standing had a poor profile of familiarity, knowledge and attitudes toward epilepsy. The pre-university and university students had a relatively good profile when compared to the published international polls. Senior medical students had an excellent level of familiarity and knowledge, but showed no change in their objection to having a son or a daughter marry an epileptic person.

CONCLUSIONS

Our data suggest that there is a clear-cut relationship between the level of education and the individual's familiarity and attitudes toward epilepsy. Effective elimination of the prejudice toward epilepsy requires specific training and not just general, superficial information about the condition.

An initially double-blind controlled 96 week trial of depot methylprednisolone against oral prednisolone in the treatment of polymyalgia rheumatica

The objective was to compare the efficacy and safety of intramuscular methylprednisolone acetate (i.m. MP) with oral prednisolone (OP) in the treatment of polymyalgia rheumatica (PMR), a common steroid-treated illness where prolonged therapy can lead to steroid side-effects. The cumulative dose with i.m. MP injections given every 3-4 weeks is considerably smaller than that with conventional OP, and may therefore be associated with fewer long-term side-effects. A hybrid design was used with an initial 12 week double-blind placebo-controlled phase followed by an open phase on active treatment up to 96 weeks. The study was multicentre hospital out-patient based and included 60 patients with untreated PMR. In the double-blind phase, either 120 mg 3-weekly i.m. MP or gradually tapering daily OP (initial dose 15 mg) were administered. In the open phase, subjects continued their active treatment with gradual tapering of the steroid dosage. The remission rate at 12, 48 and 96 weeks, and other measures of disease activity, i.e. sedimentation rate, pain and morning stiffness, and percentage of adverse reactions and serious complications such as fractures, were the main outcome measures. Sixty patients entered (30 OP:30 i.m. MP) and 49 (25 OP:24 i.m. MP) completed the study. There were similar remission rates after the double-blind phase (60.6% OP and 66.6% i.m. MP, respectively) and similar disease control in the succeeding open phase. With steroid tapering, the mean erythrocyte sedimentation rate for the entire cohort registered a significant increase in the absence of an increase in symptoms. At 96 weeks, the cumulative mean steroid dose in subjects treated with i.m. MP was equivalent to 56% that of subjects treated with OP. There were eight fractures with OP compared to one on i.m. MP. Mean weight gain was significantly greater with OP than i.m. MP (3.42 vs 0.82 kg, P < 0.005). Minor adverse reactions were similar in both groups apart from slightly increased bruising with i.m. MP. Only patients on OP reported moon face, hypertension, cataracts, back pain and depression, but the numbers were small. It is possible to achieve equivalent long-term disease control in PMR with i.m. MP compared to OP. I.m. MP was associated with far fewer fractures and lesser weight gain, presumably related to lower cumulative dose. These findings may have implications in the steroid treatment of PMR, and other rheumatic and non-rheumatic diseases.

Yap, a novel family of eight bZIP proteins in Saccharomyces cerevisiae with distinct biological functions

Saccharomyces cerevisiae contains eight members of a novel and fungus-specific family of bZIP proteins that is defined by four atypical residues on the DNA-binding surface. Two of these proteins, Yap1 and Yap2, are transcriptional activators involved in pleiotropic drug resistance. Although initially described as AP-1 factors, at least four Yap proteins bind most efficiently to TTACTAA, a sequence that differs at position +/-2 from the optimal AP-1 site (TGACTCA); further, a Yap-like derivative of the AP-1 factor Gcn4 (A239Q S242F) binds efficiently to the Yap recognition sequence. Molecular modeling suggests that the Yap-specific residues make novel contacts and cause physical constraints at the +/-2 position that may account for the distinct DNA-binding specificities of Yap and AP-1 proteins. To various extents, Yap1, Yap2, Yap3, and Yap5 activate transcription from a promoter containing a Yap recognition site. Yap-dependent transcription is abolished in strains containing high levels of protein kinase A; in contrast, Gcn4 transcriptional activity is stimulated by protein kinase A. Interestingly, Yap1 transcriptional activity is stimulated by hydrogen peroxide, whereas Yap2 activity is stimulated by aminotriazole and cadmium. In addition, unlike other yap mutations tested, yap4 (cin5) mutations affect chromosome stability, and they suppress the cold-sensitive phenotype of yap1 mutant strains. Thus, members of the Yap family carry out overlapping but distinct biological functions.

Glucose respiration and fermentation in Zygosaccharomyces bailii and Saccharomyces cerevisiae express different sensitivity patterns to ethanol and acetic acid

In the yeast Zygosaccharomyces bailii ISA 1307, respiration and fermentation of glucose were exponentially inhibited by ethanol, both processes displaying similar sensitivity to the alcohol. Moreover, the degree of inhibition on fermentation was of the same magnitude as that reported for Saccharomyces cerevisiae. Acetic acid also inhibited these two metabolic processes in Z. bailii, with the kinetics of inhibition again being exponential. However, inhibition of fermentation was much less pronounced than in S. cerevisiae. The values estimated with Z. bailii for the minimum inhibitory concentration of acetic acid ranged from 100 to 240 mmol 1(-1) total acetic acid compared with values of near zero reported for S. cerevisiae. The inhibitory effects of acetic acid on Z. bailii were not significantly potentiated by ethanol.

[Use of manual vacuum aspiration in reducing cost and duration of hospitalization due to incomplete abortion in an urban area of northeastern Brazil]

INTRODUCTION

In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA)--a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay.

METHODOLOGY

Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay.

RESULTS AND CONCLUSION

The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.

Morphometric studies on synovium in advanced osteoarthritis: is there an association between apatite-like material and collagen deposits?

OBJECTIVE

To look for the frequency and the influence of apatite-like deposits in the synovial membrane of advanced osteoarthritic joints.

METHODS

Synovium of 16 joints undergoing total arthroplasty for advanced primary osteoarthritis was embedded in paraffin. Adjacent sections were stained with alizarin red S, Mowat's pentachrome, Hematoxylin-eosin and Gomori to show apatite-like deposits, collagen, cartilage fragments, vessels, cells and iron respectively. Histomorphometry was carried out for the apatite-like and collagen deposits by the point counting method; the density of vessels and cells was also quantified.

RESULTS

14 out of the 16 specimens contained apatite-like material, mostly on the synovial surface or just beneath. There was no correlation between the apatite-like deposits and any other measured histological parameter (fibrosis, villus length, synovial lining cell width, density of synovial vessels or cells). Interestingly, the p value for a correlation between the amounts of apatite and collagen deposits was close to significance (r = 0.53; p = 0.055) when the relative volume of the apatite-like material was less than 1.2% (n = 13).

CONCLUSIONS

Apatite-like deposits are frequently observed in the synovium of late stage osteoarthritis. Although not statistically significant, these results suggest a possible association between apatite-like and collagen deposits when the amount of apatite deposits is low. Further quantitative studies are recommended to investigate this observation.

[Importance of nutritional aspects in attention deficit hyperactivity disorders]

The attention deficit hyperactivity disorder is a common childhood syndrome that is recognized as an important medical-social problem, being the object of an exhaustive investigation related to its etiology, diagnostic approach and prevention, and treatment forms. Among the factors that can alter the cerebral function, is the malnutrition. The authors discuss the association of the syndrome with the nutritional condition of students from elementary schools.

Continuous measurement of porcine renal cortex microcirculation with enhanced thermal diffusion technology

Continuous monitoring of renal cortical blood flow (RCBF) in the perioperative setting of aortic or renal vascular surgery could facilitate the early detection of vascular complications, possibly resulting in a reduction of postoperative renal failure. A new prototype system for measurement of parenchymous organ perfusion based on the principle of thermal diffusion ("TD"-Thermal Diffusion Electrode, Thermal Technologies Inc., Cambridge, MA, USA) was used for RCBF measurements in the outer cortex of the porcine kidney. We validated the sensitivity of the device to detect renal blood flow impairment, comparing TD flow data with renal artery blood flow values (RABF), measured by ultrasonic flow probes. The hypothesis was tested that acute disturbances of RCBF, induced by a variable degree of renal artery stenosis, can be immediately detected and continuously monitored by TD measurements in the porcine renal cortex. Mean baseline RCBF measured by TD electrodes was 68.1 +/- 25.0 ml/100 g/min. Mean baseline RABF was 102.1 +/- 26.6 ml/min. Controlled induction of a variable degree of renal arterial occlusion by implanted vascular balloon occluders was always followed by an immediate and proportional decline of RCBF, as measured by TD. Flow data obtained with both methods were significantly correlated by linear regression (r=.82, r2=.68; P < 0.0001). Dynamic changes of RABF in the time course of renal artery partial/total occlusion and arterial flow release could be continuously followed by detection of corresponding flow changes of RCBF. We conclude that the TD system investigated in the current study allows a continuous and sensitive determination of porcine renal cortex perfusion. A clinical evaluation of the method, e.g., in the perioperative setting of aortic or renal transplantation surgery, now appears to be justified.

Nasal tip repair with axial flap of nasal muscle

The procedure described here consists of a myocutaneous axial flap with lateral pedicle. It uses the transverse part of the nasal muscle that goes forward in rotation and the lateral and superior portions of the flap in the V-Y. The procedure is useful for repairing losses of nasal tip and the surrounding area. It is a simple method that can be used to reconstruct the brim near the tip of the nose, yielding an aesthetically and functionally efficient nose.

Anacardium occidentale (cashew) pollen allergy in patients with allergic bronchial asthma

BACKGROUND

The cashew tree grows in abundance in the hills and plains of Goa, India. Because of the financial yield, more and more trees are being planted each year. The cashew tree flowers once a year between January and March, but pollination is mostly entomophilous.

OBJECTIVE

For the first time, a study was conducted to establish the possible role of the cashew pollen in triggering allergic asthma.

METHODS

A stock solution of pollen extract was prepared with the standard weight/volume method for intradermal skin tests and a bronchial provocation tests (BPTs). The protein content of the antigen, estimated with the use of Folin phenol reagent and a spectrophotometer, was 28.72 mg/ml. Ten healthy volunteers and 65 subjects with allergic asthma, as documented by previous positive skin test reactions to various pollens, were studied.

RESULTS

Of the 65 patients, 26 (40%) had positive skin test reactions in various grades. BPTs were performed in 22 of the 26 patients after their baseline peak expiratory flow volume was assessed. Twenty (90.9%) patients had a positive BPT result, and the majority of patients had grade III and grade IV reactions. None of the control subjects (n = 10) had positive responses to either intradermal tests or the BPT. Serum IgE levels, estimated by ELISA, were high in patients with positive skin test responses and showed a linear correlation with cutaneous sensitivity. Control subjects showed normal levels of IgE (39.0 +/- 7.87 IU/ml).

CONCLUSIONS

This study provided us with knowledge of an additional pollen, Anacardium occidentale, which could trigger an asthmatic response in allergic individuals.

Complete DNA sequence of yeast chromosome XI

The complete DNA sequence of the yeast Saccharomyces cerevisiae chromosome XI has been determined. In addition to a compact arrangement of potential protein coding sequences, the 666,448-base-pair sequence has revealed general chromosome patterns; in particular, alternating regional variations in average base composition correlate with variations in local gene density along the chromosome. Significant discrepancies with the previously published genetic map demonstrate the need for using independent physical mapping criteria.

DNA inoculation as a novel vaccination method against human retroviruses with rheumatic disease associations

There are a number of rheumatologic manifestations of human retroviral infections associated with human immunodeficiency virus type I (HIV-I) and the human T-cell leukemia virus type I (HTLV-I) including arthritis, Sjøgren's syndrome-like symptoms as well as other varied autoimmune phenomena. Infection with HTLV-1 may be directly involved in the etiology and/or pathogenesis of an arthritic condition similar to rheumatoid arthritis. We have been characterizing a new vaccination strategy against human retroviral infections, designated DNA inoculation. This procedure involves the intramuscular injection of DNA plasmids which express specific human retroviral antigens. This technique results in the development of humoral and cellular immune responses against these proteins. Specifically, this method has been successfully used to develop immune responses against HIV-I and HTLV-I. The availability of rat and rabbit infection models for HTLV-I, coupled with the successful development of immune responses in these animals after DNA inoculation with an HTLV-I envelope expressing plasmid, will allow the efficacy of this vaccination technique to be evaluated with protection against in vivo viral challenge as an endpoint.

The yeast YKL741 gene situated on the left arm of chromosome XI codes for a homologue of the human ALD protein

The yeast gene YKL741 is situated on the left arm of chromosome XI, 12 kb closer to the centromere with respect to the previously localized PAS1 gene. The new yeast gene codes for a homologue of the human ALD protein (ALD: adrenoleukodystrophy). The similarity between the YKL741 protein and the ALD protein is very high in the C-terminal half, which contains an ATP-binding cassette characteristic of the ABC family of transporters. Additionally the YKL741 protein shows some similarity to the ALD protein in the N-terminal half in three putative transmembrane spanning domains. The sequence has been deposited in the EMBL data library under Accession Number X76133 SC YKL.