Comparaison de deux équations de référence pour le diagnostic des anomalies spirométriques à Cotonou / NA

Introduction : L'interprétation de la spirométrie se base sur des équations de référence, prenant en compte l'âge, le sexe, la taille et la race. Au CNHU-PPC, deux équations ont été utilisées ces dernières années : celles de l'American Thoracic Society/European Respiratory Society "ATS/ERS" (publiées en 1983, actualisées en 1993), et celles du Global Lung Initiative (GLI) 2012, désormais recommandées par plusieurs sociétés savantes. Notre étude visait à comparer les interprétations de spirométries basées sur ces équations. Matériel et méthodes : Nous avons mené une étude rétrospective descriptive, avec recrutement exhaustif des spirométries réalisées au CNHU-PPC du 1er Janvier 2018 au 31 Mars 2020. Les données recueillies furent analysées avec le logiciel R. Le coefficient Kappa a été calculé pour apprécier la performance des équations ATS/ERS par rapport au GLI 2012. Pour tous les tests statistiques, la différence était statistiquement significative pour une p-value inférieure à 0,05. Résultats : Les 955 spirométries recensées concernaient une population majoritairement féminine (sex-ratio=0,7) et jeune (âge moyen=44±20 ans). Il y avait plus de spirométries normales selon les équations ATS/ERS (53,6%, versus 53,0% selon GLI 2012 ; Kappa=0,71). Un TVO était objectivé dans 18,6% des cas selon l'ATS/ERS (versus 18,0% selon GLI 2012, Kappa=0,90). Il y avait moins de TVR selon l'ATS/ERS (21,3%, versus 29 % selon GLI 2012 ; Kappa=0,72), et moins de TVM selon l'ATS/ERS (5,3%, versus 6,6% selon GLI 2012 ; Kappa=0,79). Les proportions d'asthmatiques étaient identiques (12,3%). Les équations ATS/ERS ont objectivé moins de BPCO et de maladies restrictives (respectivement 4,6% et 21,3%) que le GLI 2012 (respectivement 5,8% avec Kappa=0,74, et 29% avec Kappa =0,72). Conclusion : Les équations ATS/ERS objectivent moins d'anomalies spirométriques que celles du GLI 2012 au CNHU-PPC. Des études ultérieures s'imposent pour intégrer les valeurs de référence béninoises au GLI 2012, actuellement récommandées pour l'interprétation de la spirométrie

Introduction: Spirometry's interpretation is based on reference equations, taking into account age, sex, height and race. At the CNHU-PPC, two equations have been used in recent years: those of the American Thoracic Society / European Respiratory Society "ATS/ERS"(published in 1983, updated in 1993), and more recently, those of the Global Lung Initiative (GLI) 2012, now recommended by several learned societies. Objectives: Our study aimed to compare interpretations of spirometry based on these equations. Material and methods: We carried out a descriptive retrospective study, with exhaustive recruitment of the spirometry done at the CNHU-PPC from January 1, 2018, to March 31, 2020. The data collected were analyzed with the software R. The Kappa coefficient was calculated to assess the performance of the ATS/ERS equations compared to GLI 2012. Results: The 955 spirometries recorded concerned a predominantly female (sex ratio=0.7) and young (mean age=44±20 years) population. There was more normal spirometry according to the ATS/ERS (53.6%, vs 53.0% according to GLI 2012; Kappa=0.71). An obstructive ventilatory disorder was objectified in 18.6% of cases according to ATS/ERS (vs 18.0% for GLI 2012, Kappa=0.90). There was less restrictive ventilation disorder according to ATS/ERS (21.3%, vs 29% for GLI 2012; Kappa=0.72), and less mixed ventilatory disorder according to ATS/ERS (5.3%, vs 6.6% for GLI 2012; Kappa=0.79). The proportions of asthma patients were identical (12.3%). ATS/ERS objectified less COPD and restrictive diseases (respectively 4.6% and 21.3%) than GLI 2012 (respectively 5.8% with Kappa=0.74, and 29% with Kappa=0.72).

The cost of total hip replacement: a multicentric TDABC comparison in Brazil / O custo da artroplastia de quadril: uma comparação multicêntrica TDABC no Brasil

Objective: Monitoring costs is critical in searching for a more effective healthcare system. This study aimed to comprehend the care pathway and measure the costs associated with hip replacement surgeries in different hospitals in Brazil. Methods: The time-driven activity-based costing method was applied for cost data collection and analyses. Data on 62 patients were retrieved from five public hospitals. A descriptive cost analysis was followed by a comprehensive analysis of the variability in each hospital's care process, leading to suggestions for cost-saving opportunities along with the surgical care pathway. As a final analysis, the cost of surgical treatment was contrasted with the national reimbursement fee. Results: The mean cost per patient of the total sample was $5,784 (MIN-MAX $2,525.9-$9,557.8). Pre- and post-surgery hospitalization periods demonstrated the highest variability in length of time and resource consumption among centers. Compared to the national best practice fee, the average cost per inpatient total hip arthroplasty (THA) pathway from all six hospitals was approximately 7x the national reimbursement. Conclusion: The application of the TDABC allowed us to identify differences in the surgical care pathway among hospitals, which could be explored in further studies aimed at designing a benchmark surgical pathway. Differences in how the treatment is delivered to patients also justified the high-cost variability among centers.

Objetivo: O custo do monitoramento é um elemento-chave na busca contínua por um sistema de saúde mais eficaz. O objetivo deste estudo foi compreender a trajetória assistencial e mensurar os custos associados às cirurgias de artroplastia do quadril em diferentes hospitais do Brasil. Métodos: O método de custeio baseado em atividades orientado pelo tempo foi aplicado para a coleta e análise de dados de custos. Os dados de 62 pacientes foram recuperados de cinco hospitais públicos. Uma análise descritiva de custos foi seguida por uma análise abrangente da variabilidade no processo de atendimento de cada hospital, levando a sugestões de oportunidades de redução de custos junto com a via de atendimento cirúrgico. Como análise final, o custo do tratamento cirúrgico foi contrastado com o valor de reembolso nacional. Resultados: O custo médio por paciente da amostra total foi de $ 5.784 (MIN-MAX $ 2.525,9-$ 9.557,8). Os períodos de internação pré e pós-operatórios demonstraram a maior variabilidade no tempo e no consumo de recursos entre os centros. Em comparação com o reembolso nacional de melhores práticas, o custo médio por cirurgia de prótese de quadril de paciente internado de todos os seis hospitais foi de aproximadamente 7x o reembolso nacional. Conclusão: A aplicação do TDABC nos permitiu identificar diferenças na via de atendimento cirúrgico entre hospitais, o que poderia ser explorado em estudos futuros que visem projetar uma via cirúrgica de referência. As diferenças na forma como o tratamento está sendo entregue aos pacientes também contribuíram para justificar a alta variabilidade dos custos entre os centros.

Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais / Application of health technology assessment (HTA) in the decision-making in hospitals

Objetivo: A incorporação de tecnologias em saúde por hospitais afeta o desempenho financeiro e assistencial do sistema de saúde de todo um país, e faltam informações na literatura sobre a aplicação de Avaliação de Tecnologias em Saúde (ATS) em hospitais no Brasil. Adicionalmente, há indícios de que a aplicação de ATS em hospitais pode melhorar o uso dos investimentos financeiros de todo o setor de saúde. O objetivo deste trabalho foi analisar a aplicação dos métodos de ATS na tomada de decisão em hospitais vinculados à Rebrats (Rede Brasileira de Avaliação de Tecnologias em Saúde). Métodos: Optou-se por utilizar o método da Grounded Theory, ou Teoria Fundamentada nos Dados, e os dados foram analisados com o uso do software ATLAS.ti. Foram realizadas entrevistas com gestores de 11 Núcleos de ATS (NATS), baseadas em roteiro semiestruturado preparado a partir dos 15 princípios orientadores para boas práticas de ATS em hospitais. Resultados: Os resultados indicaram que a ATS é aplicada de maneira incipiente no processo de tomada de decisão em hospitais. Conclusão: A análise do conteúdo das entrevistas permitiu, ainda, concluir que o sucesso dos NATS para a incorporação e desincorporação de tecnologias em saúde depende de uma cadeia de ações estratégicas relacionadas, e a falta de qualquer uma das etapas enfraquece, ou mesmo inviabiliza, a plena aplicação da ATS para a tomada de decisões em hospitais.

Objective: The incorporation of health technologies by hospitals affects the financial and healthcare performance of the health system of a whole country, and there is a lack in literature about the use of Health Technology Assessment (HTA) for decision making in Brazilian's hospitals. In addition, there is evidence that the application of HTA in hospitals can improve the use of financial investments of the whole health sector. The objective of this study was to analyze the application of HTA methods in decision making in hospitals linked to REBRATS (Brazilian Network for the Health Technologies Assessment). Methods: Grounded Theory methodology has been applied, and the interviews data were analyzed using the ATLAS.ti software. Interviews were conducted with managers of 11 hospital-based HTA units (called "NATS", Núcleo de Avaliação de Tecnologias em Saúde), based on a semi- -structured script prepared from the 15 guiding principles for good practices in hospital-based HTA units. Results: The results indicated that HTA is applied in an incipient way in the decision making process in hospitals. Conclusion: The analysis of the interviews' content also allowed us to conclude that the success of the hospital-based HTA units for the incorporation and disincorporation of health technologies depends on a chain of related strategic actions, and the lack of any of the stages weakens or even impedes the full application of HTA for decision-making in hospitals.

Clinicopathologic study based on 2 056 cases of pulmonary resection of lung adenocarcinoma / 中华胸心血管外科杂志

Objective The international multidisciplinary lung adenocarcinoma classification was published by IASLC/ ATS/ERS in 2011.This study aimed to explore the clinicopathologic characteristics of lung adenocarcinoma based on IASLC/ATS/ERS classification and validate its clinical diagnostic and therapeutic value.Methods 2 056 cases of surgical resection from Shanghai Chest Hospital were classified according to the new classification and clinical information were retrospectively reviewed.The clinicopathologic characteristics based on new classification were analyzed statistically.Results Our data indicated that women were in high risk of lung adenocarcinoma; The average age of onset was 59-year-old; the female patients were younger than the male patients (58.7 years vs 60.2 years,P ＜ 0.01) ; Average tumor diameter was 2.6 centimeter; right lung was more popular than left and superior lobe than the inferior one.Acinar predominant subtype and papillary predominant subtype were frequently observed.Micropapillary predominant subtype and solid predominant subtype were identified to be more aggressive than other histopathologic subtypes.Most patients were classified as stage Ⅰ(71.7％),which were predominantly stage Ⅰa (53.1％).Conclusion The new classification is superior to reflect the clinicopathologic characteristics of lung adenocarcinoma and satisfy clinical needs,especially contributing to change and update the surgical strategy of early stage lung adenocarcinoma.

Neumonía grave del adulto adquirida en la comunidad manejada en sala de cuidados generales en un hospital público / Severe community-acquired pneumonia in adult patients managed in a general ward at a public hospital

Introducción: la neumonía grave del adulto adquirida en la comunidad (NAC grave) se caracteriza por requerir manejo en la unidad de cuidados intensivos (UCI), dado su mayor mortalidad y riesgo de complicaciones, por lo cual se han diseñado distintas escalas de predicción de gravedad. Objetivo: identificar apacientes adultos con NAC grave manejados en la sala de cuidados generales. Pacientes y Métodos: estudio clínico descriptivo retrospectivo, se revisaron las fichas clínicas de 131 pacientes adultos egresados del servicio de medicina del hospital de Quilpué con el diagnóstico de NAC entre el 1 de enero y 31 de diciembre del 2010. Se examinaron los criterios de NAC grave de la Sociedad de Tórax Americana (ATS) y se midió el CURB-65 de 89 pacientes que consignaban esta información. Resultados: en 16 pacientes (18 por ciento) se obtuvo una puntuación del CURB-65 > 3 y en 8 pacientes (9 por ciento) se identificaron > 3 criterios menores de la ATSy en 2 de ellos un criterio mayor. Conclusión: se identificaron pacientes con NAC grave manejados en la sala de cuidados generales de un hospital publico.

Introduction: severe community-acquired pneumonia (severe CAP) is characterized by intensive care unit (ICU) requirement, given its higher mortality and complications rate. Different prediction scales have been designed to assess severity. Objective: identify adult patients with severe CAP managed in the general ward of a public hospital. Patients and Methods: retrospective descriptive study, including all adult patients dischargedfrom hospital with CAP diagnosis, from january 1st to december 31st, 2010, with a total of 131 medical records reviewed. The American Thoracic Society criteria (ATS) of severe CAP and CURB-65 scores from 89 medical records were calculated. Results: 16 patients (18 percent) had CURB-65 score > 3, 8 patients (9 percent) had > 3 minor ATS criteria, and 2 of those patients had a major criterion. Conclusion: a significant number of patients with severe CAP were managed on the general ward of a public hospital.

Changes of NO concentrations of different tissues and blood pressure in stress rats / 中国临床药理学与治疗学

AIM: To study the changes of NO concentrations of different ti ssues in stress rats. METHODS: Add stimulation with experiments employed electric food-shock and noise of busser as stressor for 15 days in SD rats,NO concentrations and BP were measured. RESULTS: In stress group, BPs increased before and after stress stimulation,but decreased levels NO concentrations of plasma, and there was no detectable amounts of NO in auricl e, ventricle, vessel and adrenal. In stress +L-arg group, BPs d id not increase before and after stress stimulation, NO concentrations of plasma increased, but auricle, ventricle, vessel and adrenal maintained the concentrat ions of NO. CONCLUSION: The stress stimulation can increase BP a nd low NO concentration, and L-arg can resist the response.

Transport mechanism of ?-lactam antibiotics in intestine and kidney / 中国临床药理学与治疗学

Some transport systems are foun d both in intestine and kidney with functional and morphological similarities, suc h as peptide transport system, organic anion transport system, organic cation tr ansport system, and P-glycoprotein-mediated transport system. All these transp ort systems participate in the transporting process of ?-lactam antibiotics in different extent. It suggests that inhibitors of renal transport may also affec t the drug absorption of the intestine.

Interleukin-2 altered the frequency -dependent relationship of intracellular calcium in rat ventricular myocytes / 中国病理生理杂志

AIM: We examined the effect of interleukin- 2 (IL-2) on calcium handlin g of rat cardiomyocytes. METHODS: The effects of steady state an d transient chan ges in stimulus frequency on the intracellular calcium transient were investigat ed in the isolated ventricular myocytes with spectrofluorometry technique. RESULTS: Under the steady state (0.2 Hz), IL-2 at 2?10 5 U/L decr eased the peak [Ca 2+ ] i and amplitude of the [Ca 2+ ] i transient, increas ed the diastolic calcium level, and prolonged the decay of the calcium transient . At 1.25 mmol/L of extracellular [Ca 2+ ], when increasing the stimulus frequency from 0.2 to 1.0 Hz, diastolic calcium level and peak [Ca 2+ ] i as well as the amplitude of the transient were inc reased. The positive frequency relationship was blunted in the IL-2-treated myoc ytes and this was not normalized by increasing extracellular [Ca 2+ ] t o 2.5 mmol/L . The caffeine induced Ca 2+ release was increased with increase in stimu lus freq uency. IL-2 inhibited the frequency relationship of caffeine induced Ca 2+ releas e. The restitution was not different between control and IL-2 groups at the 1.25 mmol/L of extracellular [Ca 2+ ], which was slowed in IL-2-treated myo cytes when t he extracellular [Ca 2+ ] was increased to 2.5 mmol/L. CONCLUSIO NS: It is concluded that the blunted frequency response of IL-2-treated myocytes was resulted from the decrease in SR Ca 2+ release, which was related to depression of SR funct ion. Despite the evidence of depressed SR Ca 2+ uptake, the restitution o f ca lcium transient at 1.25 mmol/L of extracellular [Ca 2+ ] remains uncha nged, which maybe due to the increase in the Na +/Ca 2+ exchanger activi ty.

Assessment of Smoking related Risks for Respiratory Symptoms among Elderly People

Disease risk among elderly smokers is considered to be doubled due to their smoking habits and age as compared with elderly non-smokers. The investigators conducted risk assessments of smoking for respiratory symptoms among elderly people.A questionnaire survey on smoking habits and respiratory symptoms was conducted among 3, 000 persons of 56 years of age and over who were randomly selected from suburban residents in a prefecture in Japan in October, 1997. A total 1, 954 or 65.1% of individuals responded, consisting of 42.8% for men and 57.2% for women, with an average age of 73.6 years.In addition to descriptive analysis, multiple logistic regression analysis was conducted. The results are summarized as follows:Smokers accounted for 28.1% of men and 3.6% of women. Among all age-groups, the highest rate of smokers was observed in men of 56-69 years old (34.7%) which was lower than the national average rate for the 60-69 year-old group (56.1% of men and 14.5% of women in ‘97). The odds ratios and 95 percent confidence interval (95%CI) for “having phlegm every day” and “having phlegm for more than 4 days a week” among smokers were 2.06 (95%CI=1.41-3.01) and 2.77(95%CI=1.80-4.27). Significantly higher odds ratios among smokers were also observed for “wheezing” and “shortness of breath when hurrying”.Odds ratios for some respiratory symptoms including “having phlegm for more than 4 days per week” among inhalers were significantly high compared with non-smokers, whereas those among non-inhalers were not significantly different from 1.0.Odds ratios for symptoms of phlegm and wheezing were significantly higher (Odds ratio ≥2.0) among heavy smokers (Brinkman Index [B. I.] >900) compared to non-smokers, while odds ratios of the same symptoms were not different from 1.0 among light smokers (B.I. ≤500).

Efficacy of the Antibiotics Chosen by ATS Guideline in the Treatment of Korean Patients with Community-acquired Pneumonia Admitted to a Tertiary Hospital / 결핵

BACKGROUND: In 1993, American Thoracic Society (ATS) recommended a guideline for the initial management of adults with community-acquired pneumonia(CAP). However, etiologic organisms and medical system in Korea seem to be different from those in Western countries. Retrospective analysis was done to evaluate the efficacy of antibiotics chosen by ATS guideline in the treatment of Korean patients with CAP admitted to a tertiary university medical center. METHODS: Hospitalized patients with CAP at Samsung Medical Center from April 1997 through March 1998 were retrospectively reviewed. Patients who fulfilled all of the following criteria were included in this study : (1) fever >or=38degrees C (2) purulent sputum (3) pulmonary infiltrates on chest X-ray. Patients were classified as : 1) ATS group ; patients whose initial antibiotics were chosen by ATS guideline 2) Non-ATS overuse group ; additional antibiotics administered more than those of ATS guideline, and 3) Non-ATS underuse group ; initial antibiotics were insufficient to ATS guideline. Response of empirical antibiotics and etiologic organisms of 3 groups were identified. RESULTS: Sixty-four patients were enrolled. Thirty-six patients were classified into ATS group, 10 patients Non-ATS overuse group, and 18 patients Non-ATS underuse group. Thirty-three patients of 36 ATS group, 9 patients of 10 Non-ATS overuse group, and 14 patients of 18 Non-ATS underuse group showed improvement by initial empirical antibiotics. There was no statistical difference in antibiotic response between 3 groups (p>0.05). S. pneumoniae (12.5%), K. pneumoniae(9.4%), and P. aeruginosa(4.7%), Mycoplasma(3.1%) were the most commonly isolated organisms. In 18 patients with severe CAP, P. aeruginosa was isolated only in 1 patient and Legionella organism not isolated. CONCLUSION: Initial empirical antibiotics chosen by ATS guideline were effective in the management of Korean patients with CAP admitted to a tertiary hospital. However well-designed large-scale prospective study is needed to identify etiologic organisms and choose an adequate initial empirical antibiotics in Korean adults patient with severe CAP.

Pharmacokinetics of alcohol extract of Radix Salviae Miltiorrhiaze in rat in vivo / 中草药

Objective To establish a sensitive HPLC method with UV detection for the determination of tanshinone Ⅱ_A(TSⅡ_A) and cryptotanshinone(CT) in rat plasma and to study pharmacokinetics of Radix Salviae Miltiorrhizae(RSM) liposoluble components in rat in vivo. Methods TS Ⅱ_A and CT in plasma of rat at different sampling time were determined by pretreatment with Gemifibrozil as internal standard,the protein was precipitated in methanol solution after iv administration of alcohol extract of RSM 5 mg/per animal.The mean plasma concentration-time curve was protracted and pharmacokinetic parameters were calculated by 3p87.Results The main pharmacokinetic parameters of TS Ⅱ_A were as follows: t_(1/2?) was(0.088?0.024) h;t_(1/2?) was(2.1?0.7) h;V_C was(0.8?0.6) L;CL was(2.0?1.1) L/h~(-1);AUC_(0-4) and AUC_(0-∞) were(2.2?0.9) mg?h/L and(3.4?1.7) mg?h/L,respectively.Conclusion The concentration-time curve of TS Ⅱ_A can be fitted to two-compartment model after ethanol extract of RSM iv administrated.Concentration of TS Ⅱ_A in rat plasma declines rapidly with large apparent volume of distribution.CT decreases also rapidly and it is difficult to acquire its pharmacokinetic parameters in rat.