ABSTRACT
BACKGROUND: Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost. AIM: To evaluate the prevalence of delirium at hospital admission in medically ill elderly patients and the attending physician's diagnosis and treatment of delirium. PATIENTS AND METHODS: In a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. Diagnosis of delirium was based on the Confusion Assessment Method. Medical and nurse records were reviewed. Family was interviewed when necessary. RESULTS: One hundred eight patients (52% women, age range 65-94 years) with an APACHE II score of 11.6+/-5, were evaluated. Fifty seven patients (53%) had delirium (32% hyperactive, 72% hypoactive and 5% mixed). Delirium prevalence was significantly higher in older patients (66% among those aged 75 years or older versus 30% in younger, p <0.05) and among patients with more severe conditions (88% among those with an APACHE score over 16 versus 47% below that value, p <0.05). Medical records of patients with delirium showed that this diagnosis was present only in 32% and cognitive deficit was described in 73%. Ten percent of patients with delirium received sedative medication and 38% were physically restricted. There were no environmental interventions to prevent or control delirium. CONCLUSIONS: Delirium in elderly inpatients at this unit is an extraordinarily prevalent problem, seriously under diagnosed (68%) and under treated. This study should alerts our medical community to improve the diagnosis and management of delirium in elderly inpatients.
Subject(s)
Delirium/diagnosis , Geriatric Assessment , Hospitalization/statistics & numerical data , APACHE , Aged , Aged, 80 and over , Chile/epidemiology , Delirium/mortality , Delirium/therapy , Female , Follow-Up Studies , Humans , Length of Stay , Male , Physician's Role , Prospective StudiesABSTRACT
OBJECTIVE: To study the adult Culicidae fauna in a preserved area in urban outskirts for describing species of public health concern. METHODS: This study was developed in the Tiet Ecological Park located in the outskirt of the city of S o Paulo, Brazil. Monthly collections were undertaken in three habitats at different times using electric aspirators and CDC and Shannon traps from August 1996 to March 1998. Data analysis was based on estimates of frequencies and abundance. RESULTS: Twenty-five species or generic groups were identified among 53,496 specimens collected. Ochlerotatus scapularis, Culex quinquefasciatus, and Culex declarator were the most frequent and abundant species. CONCLUSIONS: The most frequent and abundant species have been implicated in disease transmission to man in other regions. Attention must be given to these Culicidae since the study area is located near to an urban center, which could amplify the conditions for spreading vector diseases.
Subject(s)
Culicidae , Insect Vectors , Animals , Brazil , Ecosystem , Population DensityABSTRACT
OBJETIVO: Estudar a fauna de culicídeos adultos em uma área de reserva na periferia urbana para definir as espécies de interesse em saúde pública. MÉTODOS: O estudo foi realizado no Parque Ecológico do Tietê, localizado na periferia urbana da Grande Säo Paulo, Brasil. Realizaram-se coletas mensais em três locais e horários distintos, com o uso de aspiradores elétricos, armadilhas CDC e de Shannon no período de agosto de 1996 até março de 1998. O tratamento dos dados baseou-se na estimativa de freqüências e abundâncias. RESULTADOS: Coletaram-se 53.496 exemplares, tendo sido reconhecidas 25 espécies ou grupos genéricos. As espécies Ochlerotatus scapularis, Culex quinquefasciatus e Culex declarator foram as mais freqüentes e abundantes. CONCLUSOES: As espécies mais freqüentes e abundantes têm demonstrado eficiência na transmissäo de agentes patogênicos ao homem em outras regiöes. Atençäo deve ser dada a esses culicídeos, pois o local investigado, ao lado de um complexo urbano, reúne condiçöes favoráveis à disseminaçäo de doenças por vetores
Subject(s)
Insect Control , Culex , Disease Vectors , Insect Vectors , Culicidae , Epidemiological MonitoringABSTRACT
BACKGROUND: Ultrasonography is useful in trauma patients to detect pleural effusions or peritoneal fluid. AIM: To assess the value of ultrasonography performed by surgeons in the assessment of trauma patients. MATERIAL AND METHODS: A retrospective review of ultrasonography reports and clinical history of 284 trauma patients. RESULTS: One hundred fifty six patients had blunt trauma and 128 had penetrating trauma. Ultrasonography detected peritoneal fluid in 20%, pericardial effusion in 1% and pleural effusion in 1%. Eight percent had visceral damage or hematomas, without peritoneal fluid. None of the patients with a normal ultrasonography required surgery for hemoperitoneum; however, four patients had intestinal perforations and required surgery. CONCLUSIONS: Ultrasonography had a 100% sensitivity and specificity for the detection of clinically significant hemoperitoneum. Emergency ultrasonography performed by surgeons is useful and accurate.
Subject(s)
Emergency Treatment , Wounds and Injuries/diagnostic imaging , Adult , Female , Fractures, Closed/diagnostic imaging , Fractures, Closed/surgery , Hemoperitoneum/diagnostic imaging , Humans , Male , Retrospective Studies , Sensitivity and Specificity , Trauma Centers , Ultrasonography , Wounds and Injuries/surgery , Wounds, Penetrating/diagnostic imaging , Wounds, Penetrating/surgeryABSTRACT
En la actualidad se ha observado que la enfermedad bipolar tiene un pronóstico no tan favorable como se pensaba: influyen en estos aspectos psicodinámicos y psicosociales. Los psicofármacos son capaces, en gran medida, de prevenir las recurrencias y predominan en el manejo terapeútico, sin embargo las alteraciones que las enfermedades provoca en distintas áreas psicosociales y en la vida del paciente empeoran el pronóstico, haciendo necesarias las intervenciones psicoterapéuticas. Este artículo revisa someramente aspectos psicodinámicos de esta enfermedad, además de describir dos principales tipo de abordajes psicoterapéuticos (Psicoterapia familiar y Psicoterapia interpersonal)
Subject(s)
Humans , Psychotherapy , Bipolar Disorder/therapy , Parents/education , Psychotherapy, Group , Bipolar Disorder/psychology , Family Relations , Countertransference , Crisis Intervention , Psychotherapeutic Processes , Transference, PsychologyABSTRACT
Foram coletadas larvas de Aedes albopictus em uma planta da família Bromeliaceae, na periferia da cidade de Säo Paulo, SP, Brasil. Esse encontro abre perspectivas de estudo para avaliaçäo do potencial desse vegetal como criadouro desse mosquito no País
Subject(s)
Aedes , Disease Vectors , Plants , Insect Vectors , LarvaABSTRACT
Foram feitas coletas de mosquito (Diptera: Culicidae) na área do projeto de Colonizaçäo Pedro Peixoto, no Estado do Acre, Brasil. Obteve-se um total de 4.588 exemplares pertencentes a 53 espécies ou grupos. Salienta-se a ocorrência de Anopheles (Nyssorhynchus) oswaldoi
